Respiratory epithelial adenomatoid hamartoma: a review

Respiratory Epithelial Adenomatoid Hamartoma at an Unusual Location: A Case Report and Literature Review

Respiratory epithelial adenomatoid hamartoma (REAH) in the head and neck is a rare benign lesion containing glandular tissue covered with ciliated respiratory epithelium. In the head and neck, REAH of the nasal cavity, paranasal sinuses, and nasopharynx have been reported in literature. Due to rareness of REAH and insufficient knowledge of its imaging features, the diagnosis can be challenging when we encounter a non-specific cystic mass at an uncommon site in the head or neck. Here, we report the case of a pathologically confirmed REAH showing a cystic mass centered at the buccal space (retromaxillary fat pad) with CT and MRI findings.

An Inflammatory Polyp-Like Benign Sinonasal Mass Lesion - Respiratory Epithelial Adenomatoid Hamartoma: A Case Report

Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon, benign glandular proliferation that arises from the surface epithelium of the nasal cavity and paranasal sinuses. Here we report a case, wherein a 62-year male from northern Kerala presented with bilateral nasal obstruction, loss of sense of smell, and bilateral nasal discharge. On examination, a polypoidal lesion was observed in the left nasal cavity, filling the entire left middle meatus. Diagnostic nasal endoscopy revealed a multilobulated polypoidal mass in the left nasal cavity extending posteriorly into the nasopharynx and causing partial occlusion of the (R) choana. Computerized tomography(CT) imaging was suggestive of a mass in (L) nasal cavity extending from the frontal sinus to the inferior turbinate and posteriorly extending into the nasopharynx. The patient underwent Endoscopic endonasal excision of the (L)nasal mass and intraoperatively the mass was seen to arise from the septum in the (L) nasal cavity posteriorly. Histopathological examination confirmed the diagnosis of REAH. This case report emphasizes the significance of including REAH in the differential diagnosis of sinonasal masses as it simulates other inflammatory disorders. Appropriate diagnosis by biopsy prevents unnecessary aggressive surgery as this benign condition mimics malignant lesions. More research is needed to understand the etiopathogenesis and diagnostic usefulness of immunohistological staining in REAH.

Nasopharyngeal Respiratory Epithelial Adenomatoid Hamartoma-Master of Masquerade

OBJECTIVES

To highlight a case of nasopharyngeal Respiratory Epithelial Adenomatoid Hamartoma (REAH) in a female patient with chronic nasal block.

METHODS

A single case report of a female patient with the diagnosis of REAH, detailing her presenting symptoms, clinical findings, management and follow up.

RESULTS

Histopathological assessment of the excised nasopharyngeal polyp was consistent with a diagnosis of REAH with a discussion on the disease and its current literature reviews.

CONCLUSION

The incidence of REAH within the nasopharynx remain rare with only few cases described in literature, especially in females.

Respiratory Epithelial Adenomatoid Hamartoma in a Young Female: A Diagnostic Dilemma

Hamartomas are non-neoplastic tissue abnormalities commonly found in various organs but rarely in the upper aerodigestive tract. Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign proliferation affecting the nasal cavity and sinonasal tract. It often mimics other nasal masses, leading to diagnostic challenges. We present the case of a 25-year-old female with recurrent epistaxis and chronic bilateral nasal obstruction. Diagnostic endoscopy revealed a polypoidal mass, later confirmed as REAH through histopathological examination. CT scans demonstrated soft tissue opacity but no erosion of surrounding bony structures. The patient underwent endoscopic excision, and the excised mass exhibited characteristic histological features of REAH. Endoscopic excision with careful postoperative follow-up can lead to successful outcomes in REAH cases. A year of follow-up revealed no recurrence.

Novel insights into central compartment atopic disease - a literature review

INTRODUCTION

Central compartment atopic disease (CCAD) is a newly recognized variant subtype of chronic rhinosinusitis (CRS). Although CCAD has been reported to be correlated with allergy, there is still a considerable gap in our knowledge regarding CCAD.

AREAS COVERED

We have conducted a thorough analysis of the literature on CCAD. This review provides current understanding and therapeutic strategies of CCAD. In this article, we will review the clinical presentations and parameters, allergy-related etiology, endotypes, and recommended management of CCAD.

EXPERT OPINION

CCAD is considered as an aeroallergen-driven type 2/eosinophilic inflammatory pattern. Although CCAD can be diagnosed by endoscopy and radiology, as well as allergen test, pathogenesis and management strategies leave much to be desired, and further studies are needed.

Respiratory Epithelial Adenomatoid Hamartoma

BACKGROUND

Respiratory Epithelial Adenomatoid Hamartoma (REAH) is an uncommon, benign tumor of the sinonasal tract. It can, however, be confused with a sinonasal malignancy causing undo morbidity to patients. Therefore, the clinical as well as histological diagnosis is crucial in order to correctly care for patients.

METHODS

This review of a patient, to include their clinical pictures, radiologic pictures, and histologic pictures, allow for the clinician to accurately evaluate and diagnose REAH.

RESULTS

Our patient presented with a classic bilateral olfactory cleft mass on endoscopic exam. CT was obtained showing a non-enhancing homogenous mass, widening the olfactory cleft, with no evidence of skull base defects or bony erosion. MRI was additionally obtained, given the location, showing a homogenous cribriform mass with clearly defined borders with post-contrast enhancement on T1-weighted images and hyperintense T2-weighted images. A biopsy in clinic was done, showing small to medium, round to oval shaped glands lined with ciliated respiratory epithelium and separated by stroma. The surface epithelium extends into the submucosa, communicating with the proliferating glands.

CONCLUSION

Our patient, presented in this case report, shows a classic presentation of REAH. Using these findings, patients can be better counseled on this benign entity, ranging from observation to surgical intervention.

Septochoanal Polyp on the Concave Side of the Deviated Nasal Septum

The septochoanal polyp is one of the choanal polyps derived from the nasal septum. They rarely occur, with only a few cases reported in the English literature. The etiology is still uncertain though it is thought to be associated with inflammation. Pathological findings generally show chronic inflammatory polyps and should be differentiated from other tumors. We report a case of a 32-year-old man diagnosed with a septochoanal polyp on the concave side of the deviated nasal septum. Previous reports have not mentioned the relationship between septochoanal polyp and the direction of septal deviation. This case is a practical example when considering the potential causes of the septochoanal polyp.

Fibroepithelial Polyps Originating from the Posterior Nasal Septum: A Case Report

Fibroepithelial polyps are benign tumors of mesodermal origin. They rarely occur in the nasal cavity, with only four such cases reported in the relevant English literature. The location was the inferior turbinate in three cases and anterior nasal septum in one case. The etiology has been suggested in other organs; however, it is entirely unknown in the nasal cavity. Pathological findings play an essential role in the diagnosis of fibroepithelial polyps. We report the case of a 76-year-old woman with fibroepithelial polyps originating from the posterior part of the nasal septum. The fibroepithelial polyps were white-yellow lobular masses that differed from a common inflammatory polyp. We made the diagnosis by excluding the other possible tumors based on a pathological examination. This is the first report about fibroepithelial polyps arising from the posterior nasal septum. She had no potential risk factors that might trigger fibroepithelial polyps in the nasal cavity. This case is a valuable example when considering the potential causes (e.g., female hormones and mechanical pressure) of nasal fibroepithelial polyps.

Prevalence of respiratory epithelial adenomatoid hamartomas (REAH) associated with nasal polyposis: an epidemiological study - how to diagnose

OBJECTIVES

To highlight the prevalence of respiratory epithelial adenomatoid hamartomas in the olfactory cleft of patients with nasal polyposis. To demonstrate characteristics indicative of hamartoma on the CT scans of paranasal sinuses during surgery and in histopathological exams.

METHODS

Cross-sectional study carried out in Hospital das Clínicas da UFMG and Núcleo de Otorrino BH. We performed 114 nasal endoscopic surgeries for polyposis, between February 2015 and November 2019. We assessed the olfactory cleft width in all preoperative CT scans. Upon seeing an indication of hamartoma on the CT scan, we took a tissue sample from the olfactory cleft during the surgery and sent for histopathological exam. We referred the samples to a pathologist experienced in the anatomopathological diagnosis of respiratory epithelial adenomatoid hamartomas.

RESULTS

Of the 114 patients with polyposis, 54 (47.4%) had olfactory cleft enlargement and, 100% of them had tissue with a dense and hardened polypoid aspect, with a slight cerebriform appearance in this region during the surgery. Histology confirmed a respiratory epithelial adenomatoid hamartoma.

CONCLUSION

This observation suggests that the presence of hamartomas in polyposis is common, but underdiagnosed.

LEVEL OF EVIDENCE

Step 3 (Level 3).

Not just another nasal polyp: Chondro-osseous respiratory epithelial adenomatoid hamartomas of the sinonasal tract

OBJECTIVES

Chondro-osseous respiratory epithelial adenomatoid hamartomas (COREAH) are extremely rare benign lesions in the sinonasal cavity. We aim to (a) report two cases of COREAH and (b) perform a literature review with a summary on previously published cases of COREAH till August 2019.

METHODS

A literature review identified 16 cases, but only 12 cases from publications from 2005 to 2019 were included in analysis. In addition, we report two cases of COREAH from our tertiary academic medical center.

RESULTS

COREAH is found in patients from 3 to 83 years old. It originates from various sites in the nasal cavity and sinuses but the most common location is the lateral nasal wall. Calcification on imaging is a common finding.

CONCLUSION

COREAH is an uncommon entity that is important to recognize and distinguish from other sinister nasal masses. It is a slow growing benign lesion which lacks aggressive features on imaging. Future studies are needed to evaluate the possibility of an underlying genetic predisposition.

LEVEL OF EVIDENCE

4.

Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base

Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.

Beware the respiratory epithelial adenomatoid hamartoma-a malignant masquerador

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign tumour, which can masquerade as a sinonasal malignancy. Commonly arising from the posterior nasal septum, we present the second described case of a lateral nasal cavity wall REAH in a 68-year-old male with a 2-year history of progressive left nasal obstruction. Clinical and radiological assessment predicted malignancy; however, histopathology identified a benign pathology. He was subsequently treated with narrow local excision under general anaesthetic with no evidence of recurrence at post-operative intervals.

Preoperative Endovascular Embolization in an Easily Bleeding Respiratory Epithelial Adenomatoid Hamartoma of the Olfactory Cleft: A Case Report

Respiratory epithelial adenomatoid hamartomas (REAHs) are rare tumors occurring in the nasal cavity and sinuses, and their etiology is unknown. REAH is a relatively recently established lesion and is often misdiagnosed as nasal polyposis or other tumors. Preoperative endovascular embolization for sinonasal tumors is now widely accepted as an effective method to reduce blood loss, soften the tumor, and facilitate surgical procedures. However, to the best of our knowledge, there are no reports of the requirement for preoperative embolization in the management of REAH. Here, we present a 70-year-old man with an easily bleeding REAH of the olfactory cleft, vascularized by branches of the bilateral internal and external carotid arteries. We removed the tumor endoscopically after preoperative embolization of the bilateral sphenopalatine arteries. Histological investigation revealed an intratumoral hemorrhage accompanying the REAH, with no evidence of a residual or recurrent tumor during the last follow-up at 3 months. In conclusion, accurate preoperative diagnosis and proper preoperative interventions such as embolization are needed for safe and adequate treatment of REAHs that have an abundant blood flow.

Respiratory Epithelial Adenomatoid Hamartoma: A Very Rare Entity Originating from the External Auditory Canal

Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon lesion of the upper aerodigestive tract. It is characterized by abnormal glandular formations with ciliated epithelium arising from the nasal cavity, paranasal sinuses and nasopharynx, but other locations have also been described. We did not find any other cases of this hamartomas in the external auditory canal in the literature. A 40-year-old man was referred to the otorhinolaryngology department due to otorrhea and decreased hearing from 1 year ago. Otoscopic examination showed a reddish hemorrhagic mass in the left external auditory canal. Intraoperatively, the tumor was completely resected. The pathologic findings were consistent with REAH.

An atypical presentation of a Respiratory Epithelial Adenomatoid Hamartoma, a case report

Introduction

Respiratory Epithelial Adenomatoid Hamartoma (REAH) is a benign disease that can resemble other malignant entities. Thus, it is essential to diagnose it accurately as the treatment approach differs, from radical surgeries in malignant cases, to a simple excision in hamartoma. We present an unusual case of bilateral REAH that was misdiagnosed, and hence it was treated aggressively.

Case report

A 57-year-old male patient presented with anosmia, 2-years history of bilateral nasal obstruction, and was accompanied with a moderate headache. An impression of olfactory neuroblastoma was made after history taking physical examination, and imaging studies. The patient underwent Functional Endoscopic Sinus Surgery (FESS), excisional biopsy of the cribriform plate mass bilaterally, and superior septectomy. Histopathologic examination of the bilateral masses showed sinonasal polyposis with crypting of surface mucosa and pseudoglandular formation. A diagnosis of sinonasal polyps with REAH was established. The patient's nasal obstruction improved, with no recurrence of sinusitis ± polyposis. However, he still complains of anosmia after 2-years follow-up.

Conclusion

Although REAH is a benign disease, it is critical to reach the correct diagnosis, in order to avoid aggressive treatment. Unfortunately, the preoperative investigations were not consistent with REAH, thus it was misdiagnosed and treated aggressively.

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Respiratory Epitheliel Adenomatoid Hamartoma (REAH) is a benign disease that can resemble other malignant diseases.

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The disease is commoner in males and in the third to ninth decades of life.

•

The significance of this article is to share our experience with this disease as we did not diagnose the case accurately. Thus the patient was treated aggressively for a malignant case, instead of a simple excision. Hence, one should keep REAH in mind when encountered a similar case to ours.

Lateral Nasal Wall Respiratory Epithelial Adenomatoid Hamartoma (REAH): A Diagnostic Conundrum

INTRODUCTION

This study aims to report a rare case of a respiratory epithelial adenomatoid hamartoma (REAH) of the lateral nasal wall that had initially presented as a fungating mass, similar to that of a sinonasal malignancy, and its complete removal from the lateral nasal wall.

CASE REPORT

We report the case of a 58-year-old woman who presented to us with a chief complaint of recurrent right-sided epistaxis and nasal blockage for the past 4 months, which was progressively worsening. Histopathological examination confirmed the presence of a REAH instead of a sinonasal malignancy. The tumor was surgically excised from the lateral nasal wall using electrocautery under endoscopic guidance. The patient was then carefully followed-up after surgery, and the wound was successfully healed 3 months after the initial surgery. There was no evidence of recurrence 6 months after the initial surgery.

CONCLUSION

This case demonstrates the rare presentation of a REAH, which had arisen from the lateral nasal wall. Clinically, it is difficult to distinguish a REAH from a more notorious mass such as a sinonasal malignancy. Therefore, biopsy is mandatory in all cases of lateral nasal mass in order to rule out malignancy before confirming nasal REAH. Fortunately, as seen in this case, a lateral nasal REAH, once diagnosed, can be safely and easily removed from the lateral nasal wall using electrocautery with good surgical outcomes and a low rate of recurrence.

Sinonasal Respiratory Epithelial Adenomatoid Hamartomas: Series of 51 Cases and Literature Review

Background

Respiratory epithelial adenomatoid hamartomas (REAHs) are rare, benign glandular proliferations of the nasal cavity, paranasal sinuses, and nasopharynx. This study aimed to expand our understanding of this entity by presenting a series of REAHs combined with a review of the pertinent literature.

Methods

A retrospective review was performed on all patients with a diagnosis of REAH from 2002 to 2011. Data were collected with respect to age, gender, clinical presentation, imaging, histopathology, treatment, and outcome. Because olfactory cleft expansion by imaging evaluation has been reported to suggest REAH, maximum olfactory cleft (MOCs) widths were also measured.

Results

Fifty-one cases of REAH included 37 male (72.5%) and 14 female subjects (27.5%) with a mean age of 58.4 years. Headache, nasal obstruction, rhinorrhea, and hyposmia were the most common presenting symptoms. Although 35(68.6%) were associated with concurrent inflammatory pathology, 16 (31.4%) presented as isolated lesions of the nasal cavity. Enlargement of MOCs was evident on computed tomography, with mean MOCs of 8.64 and 9.4 mm, in the coronal/axial planes, respectively. There were no statistically significant differences between MOCs of isolated (7.96 mm) versus MOCs of associated (9.63 mm) lesions (p = 0.25). Forty-nine were treated with endoscopic resection without evidence of recurrence after a mean follow-up of 27.2 months.

Conclusion

REAHs are rare sinonasal lesions that may appear as localized, isolated masses or more diffuse when in conjunction with other inflammatory processes. Irrespective of clinical presentation, endoscopic removal appears to be curative. Differentiation from more aggressive lesions is paramount to avoid unnecessarily radical surgery for an otherwise benign process.

Respiratory Epithelial Adenomatoid Hamartoma: An Important Differential of Sinonasal Masses

Background

Respiratory epithelial adenomatoid hamartomas (REAH) are rare, glandular proliferations of the aerodigestive tract lined by ciliated respiratory epithelium. We report nine cases of REAH and devised a histopathological guide to differentiate these lesions from its main differentials.

Methods

Patients with biopsy-proven REAH were included in the series. Lesions were removed endoscopically and sent for histopathological analysis. The macroscopic and microscopic features were reviewed.

Results

Nine patients (age 59 ± 15.5 years, 78% male) with REAH were analysed. Findings revealed glandular proliferations lined by ciliated respiratory epithelium without metaplastic changes and intervening oedematous stroma. This is in contrast to a typically thickened epithelial basement membrane with oedematous stroma seen in nasal polyps.

Conclusion

REAHs are benign entities that should be included in the differential diagnosis for sinonasal masses. Prompt detection by tissue biopsy is crucial to differentiate these lesions from nasal polyps and more aggressive pathologies and avoid unnecessary surgery.

Bilateral respiratory epithelial adenomatoid hamartomas originating from the anterior olfactory clefts

A respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon benign lesion often found in the sinonasal tract. We present a case of bilateral REAH originating from the anterior olfactory cleft treated with endoscopic surgical resection without recurrence. We highlight the characteristics of REAH and necessary steps to ensure proper diagnosis and treatment.

Low-Grade Epithelial Proliferations of the Sinonasal Tract

Low-grade epithelial proliferations of the sinonasal tract include Schneiderian papillomas, respiratory epithelial adenomatoid hamartoma, seromucinous hamartoma and low-grade non-intestinal adenocarcinoma. There is considerable overlap in their clinical presentation, endoscopic appearance, and imaging features. Although well-described diagnostic criteria exist, a definitive diagnosis may be difficult to reach on a small biopsy. Schneiderian papillomas are divided into fungiform, inverted, and oncocytic types, each with characteristic clinical and morphological features. The latter two may progress to malignancy. The majority are still considered to be HPV-related. Two lesions are designated as hamartomas, but their pathogenesis remains uncertain, with inflammatory and neoplastic origins proposed. Respiratory epithelial adenomatoid hamartoma is increasingly being recognized for its association with chronic rhinosinusitis and olfactory cleft site of origin. Seromucinous hamartoma has gained attention in recent years and overlaps with both respiratory epithelial adenomatoid hamartoma and low-grade non-intestinal adenocarcinoma. Controversy surrounds their distinction, particularly from low-grade adenocarcinoma. The latter generally is cured by complete excision, with a 26 % risk of recurrence but rare metastases and deaths from disease.

Comprehensive review on endonasal endoscopic sinus surgery

Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.

Nasal Cavity Masses Resembling Chondro-osseous Respiratory Epithelial Adenomatoid Hamartomas in 3 Dogs

Chondro-osseous respiratory epithelial adenomatoid hamartomas (COREAHs) are rare tumors in the nasal cavity of people, which have not been described in other species. COREAHs in people are minimally invasive and rarely recur following excision. Histologically, these tumors are composed of disorganized, mature, nasal turbinate tissue that is organized into polypoid growths. These growths are lined by respiratory epithelium, contain glandular elements, and are organized around central cores of chondro-osseous matrix. This report describes 3 cases of dogs with nasal tumors that have histomorphology similar to that of COREAH in people. The tumors were all identified within the nasal cavity and were associated with regional bony lysis of the turbinates and surrounding skull bones, a feature that has not been reported in COREAH in people. There was no evidence of metastasis or extension beyond the nasal cavity in any of the 3 cases.

Respiratory epithelial adenomatoid hamartoma of the nose: an updated review

BACKGROUND

This study was designed to update clinical and imaging features as well as treatment outcomes of the nasal respiratory epithelial adenomatoid hamartoma (REAH). Data sources included case reports, original articles, and reviews published in English or French in PubMed from 1995 to date.

METHODS

Only published articles that met Wenig's histological criteria for the diagnosis of REAH were included.

RESULTS

REAH is not rare and is probably underdiagnosed. It is usually observed in the fifth decade of life with a 3:2 male/female predilection. REAH can be represented in two forms: as an isolated lesion (less frequent) or in association with an inflammatory process (especially nasal polyposis). It was observed in 35-48% of patients undergoing endoscopic endonasal surgery for nasal polyposis. Its origin is found, in most cases, in the olfactory cleft, which is exhibited on computed tomography (CT) scans by widened opacified olfactory clefts without bone erosion. Resection of REAH from the olfactory clefts does not worsen, but instead, can improve the sense of smell after surgery.

CONCLUSION

Looking for REAH on CT scans and during endoscopic examination can lead to its diagnosis and help avoid aggressive surgical procedures and their complications. Endoscopic resection is the treatment of choice. The removal of REAH constitutes a specific surgery on the olfactory clefts, which can improve nasal obstruction as well as sense of smell. Whether REAH can be defined as a hamartoma, an inflammatory reactive process, or a neoplastic lesion remains to be determined.

Clinicopathological and EBV analysis of respiratory epithelial adenomatoid hamartoma

Background

To investigate the clinicopathological characteristics of respiratory epithelial adenomatoid hamartoma (REAH) in residents of Southern China and to study the correlation between REAH and Epstein-Barr virus (EBV).

Methods

Clinicopathological data of 53 cases of REAH were retrospectively analyzed. The immunoreactivity for CK 7, CK20, CEA, p53, and Ki-67, Alcian blue–periodic acid-Schiff (AB-PAS) staining and in situ hybridization for EBV-encoded RNA (EBER) were carried out.

Results

REAH lesions were covered with ciliated columnar epithelium and proliferation of subepithelial glands, which were positive for CK7, and negative for CK20, CEA, and p53. Goblet cell metaplasia was stained blue by AB-PAS. The frequency of EBER positive cases in REAH located in nasopharynx was 27.78%, compared with that in the nasal cavity (15.79%) and paranasal sinuses (12.50%), there were no statistical differences.

Conclusions

REAH is an uncommon entity with distinctive morphologic features and EBV may have nothing to do with REAH.

Virtual slides

The virtual slide(s) for this article can be found here:

http://www.diagnosticpathology.diagnomx.eu/vs/5875687401178748

MRI in respiratory epithelial adenomatoid hamartoma of nasal cavities

This is a report of six cases of respiratory epithelial adenomatoid hamartoma of the nasal cavities that were characterized by: symptoms of nasal obstruction and dysosmia; endoscopic appearances of bilateral nasal polyposis affecting the olfactory clefts; CT imaging showing enlargement of the olfactory clefts; MRI (rarely reported in the literature) revealing clearly delineated cerebriform tissue filling in the olfactory clefts; histological confirmation in all cases; and recovery after surgical endoscopic resection without the need for associated sinus surgery.

CT findings of sinonasal respiratory epithelial adenomatoid hamartoma: a closer look at the olfactory clefts

BACKGROUND AND PURPOSE

Respiratory epithelial adenomatoid hamartoma is a benign glandular neoplasm of the sinonasal cavities, which presents in isolation (REAHi) or in the setting of an adjacent inflammatory process such as sinonasal polyps. It is frequently found in the olfactory clefts. CT features of the 2 clinical presentations have not been well defined. We present the CT findings of REAH, focusing on the degree of associated sinusitis and changes in the OCs. We hypothesized that widening of the OCs and associated severity of the sinusitis are diagnostic features of REAH, differentiating it from SNP.

MATERIALS AND METHODS

In this case-control study, we compared patients with REAHi, those with REAH in the setting of SNP (REAHsnp), and those with SNP only (control patients). Patients with REAH were excluded if they had an adjacent inflammatory process other than SNP or if they did not have disease in the OC. We analyzed Harvard sinus CT scores and OC dimensions.

RESULTS

A total of 29 patients with REAH were included: 7 with REAHi and 22 with REAHsnp. A total of 26 control patients were identified. Patients with REAHi had significantly lower Harvard CT scores than did the other groups. The OC width and the ratio of OC to the total nasal distance were significantly larger in both REAH groups compared with those of the control patients. If the OC is 10 mm or more, the sensitivity and specificity for the presence of REAH are 88% and 74%, respectively.

CONCLUSIONS

Both clinical presentations of REAH are associated with OC widening on CT scan. In the setting of polypoid disease, an OC width of > 10 mm should increase suspicion for the presence of REAH.