Vascular hamartoma of the paranasal sinuses

Nasal vascular hamartoma in a Domestic Shorthair cat

A nasal mass in a Domestic Shorthair cat was causing facial deformity, sneezing and intermittent epistaxis. Biopsy samples obtained previously had been non-diagnostic. Computed tomography images revealed an irregular, contrast-enhancing mass occupying a large portion of the righthand side of the nasal cavity. Previously described criteria for malignancy were not present. A ventral surgical approach combined with temporary, ipsilateral, common carotid arterial occlusion provided excellent access for debulking the lesion and collecting samples for histopathology. A nasal vascular hamartoma was diagnosed and clinical signs resolved postoperatively. This is the first documentation of this abnormality in the cat. Hamartomatous abnormalities should be included on the list of differential diagnoses for feline nasal mass lesions. The prognosis for hamartomatous lesions postoperatively is good, in keeping with their limited propensity for growth after maturity.

Vascular Hamartoma of the Paranasal Sinuses: Report of 3 Rare Cases and a Short Review of the Literature

The paranasal sinuses are an extremely unusual location for a vascular hamartoma. As far as we know, only 1 such case has been previously reported in the English-language literature. We report 3 new cases of vascular hamartoma of the paranasal sinuses, which occurred in a 20-year-old woman and in 2 men aged 36 and 45 years. Radiologically, the lesion in the woman was confined to the sinuses, while evidence of intraorbital extension was seen in the 2 men. No intracranial extension was seen in any patient. The diagnosis was confirmed by histopathologic examination of the excised lesions. All 3 patients were alive without recurrence at 12 to 24 months of follow-up.

Frontal sinus hamartomas

OBJECTIVE

To review the entity of respiratory epithelial adenomatoid hamartoma of the paranasal sinuses using an illustrative case example of frontal sinus hamartoma.

METHODS

Case report with review of the literature.

RESULTS

Respiratory epithelial adenomatoid hamartoma represents a benign process that is generally cured with conservative surgical resection of the involved area. Nevertheless, as shown in our case example, this can be a locally aggressive process that can lead to significant morbidity if left untreated.

CONCLUSION

Hamartomas of the paranasal sinuses represent a rare entity, which should be considered in the differential diagnosis of expansile sinonasal lesions. Treatment of choice is surgical resection. Frontal sinus involvement may extend into the surrounding orbit and intracranial cavities, which may need to be addressed with standard skull base surgery techniques.

Respiratory epithelial adenomatoid hamartoma in the nasal cavity

We report a 65-year-old male with a hamartoma in the left nasal cavity. A mass was found in the left nasal cavity and was diagnosed as a benign tumor on the basis of preoperative findings. Left lateral rhinotomy was performed to completely remove it and the lesion was found to have arisen from the inferior turbinate. The pathological diagnosis was respiratory epithelial adenomatoid hamartoma. We discuss the pathological features of this disease.

Nasal chondromesenchymal hamartoma: an upper respiratory tract analogue of the chest wall mesenchymal hamartoma

Nasal chondromesenchymal hamartoma is the suggested appellation for a tumefactive process of the nasal passages and contiguous paranasal sinuses in seven children with a detectable mass in the nose. With the exception of one patient who was 7 years of age at diagnosis, the others were 3 months of age or less upon recognition of the mass. Two children were diagnosed in the first 2 weeks of life. Imaging studies showed a complex solid and cystic mass or masses filling the nasal cavity and extending into the ethmoid sinuses in most cases. Erosion of the surrounding bone, including the cribriform plate, resulted in an intracranial component in the four cases. Surgical resection was the treatment of choice despite its technical difficulties that often necessitated a combined intranasal and intracranial approach. Residual disease with continued growth in one case was the clinical outcome in two children, and the remaining five patients have not experienced any further difficulties. The piecemeal fragments of tissue disclosed a collage of histologic features, but the basic morphologic elements were well-demarcated nodules of cartilage with some variation in the cellular density and maturation of the chondrocytes, a myxoid to spindle cell stroma, focal osteoclastlike giant cells in the stroma, and erythrocyte-filled spaces resembling those of the aneurysmal bone cyst. Two of the tumors were less polymorphous or complex in their spectrum of histologic features. These nasal masses have similarities to the so-called chest wall hamartoma or mesenchymal hamartoma of the chest wall in terms of the clinical presentation in infancy and the basic cartilaginous character of both entities. There is a degree of presumption in the designation of these nasal and chest wall tumors as hamartomas because the pathogenesis has not been established for either entity.