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 associated with nasal polyposis

Hamartoma is a rare, non-neoplastic tumor characterized by an abnormal mixture of tissues, which are indigenous to the region. They are rare in the nasal cavity. We report a 79-year-old woman with an adenomatoid hamartoma in the left nasal cavity associated with nasal polyposis. This association supports the hypothesis that inflammation is one of the factors that induce the development of a hamartoma. Functional endoscopic sinus surgery was performed to completely remove it, and this lesion was found to have arisen from the lateral nasal wall. It is an unusual localization because the most common site in the nasal cavity is the nasal septum, particularly the posterior aspect. Limited but complete surgical resection is the treatment of choice. Although adenomatoid hamartoma arising from the sinonasal tract is very rare, head and neck surgeons should be aware of this pathological entity as a differential diagnosis for inverted papilloma and adenocarcinoma. Misinterpretation of these lesions as a true neoplasm may result in unnecessarily aggressive surgery for this benign lesion.     

Respiratory epithelial adenomatoid hamartoma: a case report

Respiratory epithelial adenomatoid (READ) hamartoma is a recently described entity characterized by abnormal glandular formations arising from the epithelium of the nasal cavity. The etiology of the lesion is unclear and may be secondary to either sinonasal inflammation or developmental error. We present a case of a 54-year-old man with a unilateral nasal mass found to be consistent with READ hamartoma upon pathologic review. Although READ hamartomas are thought to be rare, awareness of the lesion is important since it may be confused with sinonasal adenocarcinoma, leading to overly aggressive treatment. Therefore, READ hamartoma should be included in the differential diagnosis of a unilateral nasal mass.     

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.     

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.     

Rare case of a respiratory epithelial adenomatoid hamartoma of the nasal cavity, maxillary sinus et ethmoid sinuses: a clinicopathologic study

A case of the respiratory epithelial adenomatoid hamartoma of the nasal cavity, maxillary sinus and ethmoid sinuses for the first time in the polish literature was reported. Characteristic clinical symptoms and histopathologic features, diagnosis and surgical intervention as well differential diagnosis were introduced.     

鼻腔嗅裂区呼吸道上皮腺瘤样错构瘤的CT影像表现

目的 探讨鼻腔嗅裂区呼吸道上皮腺瘤样错构瘤的特征性CT影像表现及其与慢性鼻窦炎鼻息肉在CT表现上的区别。 方法 (1) 回顾性分析17例经组织病理学证实的双侧嗅裂区呼吸道上皮腺瘤样错构瘤的CT资料,探讨其影像学特点。(2) 分别测量17例错构瘤患者、36例鼻息肉患者和41例正常人在轴位和冠状位CT上的嗅裂区的宽度和鼻腔总宽度,计算嗅裂宽度和鼻腔宽度的比值,并进行统计学分析。 结果 错构瘤患者的CT层面上显示嗅裂区有与脑灰质呈等密度的软组织影,嗅裂宽度增大。嗅裂宽度的中位数,在轴位和冠状位CT上分别是,错构瘤组11.5 mm和11.8 mm,鼻息肉组7.5 mm和7.8 mm,对照组5.4 mm和5.4 mm。各组间差异均有统计学意义(所有P< 0.001)。鼻腔的总宽度在各组中及两个扫描方位上均没有显著差异。嗅裂宽度和鼻腔宽度比值的中位数,在轴位和冠状位CT上分别是,错构瘤组45.5%和43.5%,鼻息肉组30.0%和30.0%,对照组为22.0%和21.0%。各组间差异均有统计学意义(所有P< 0.001)。 结论 错构瘤组CT扫描下的嗅裂宽度及嗅裂宽度和鼻腔总宽度的比值较正常组和鼻息肉组显著增加。嗅裂膨胀性增宽是提示错构瘤的特征性征象之一,其可以作为错构瘤与鼻息肉鉴别诊断的参考依据。尤其是双侧对称增宽更有诊断价值,双侧嗅裂宽度大于10 mm应高度怀疑有错构瘤的可能性。     

Respiratory epithelial adenomatoid hamartomas and chondroosseous respiratory epithelial hamartomas of the sinonasal tract: a case series and literature review

BACKGROUND: Respiratory epithelial adenomatoid hamartomas (REAH) and chondroosseous respiratory epithelial (CORE) hamartomas are rare sinonasal/nasopharyngeal lesions first characterized in 1995. Although REAH and CORE hamartomas are benign, nonneoplastic lesions, awareness and recognition of these lesions are important because they can be confused grossly and microscopically with more threatening sinonasal tumors. METHODS: This report presents two cases of REAH and one case of a CORE hamartoma. The literature regarding REAH and CORE hamartomas is reviewed, and their distinction from related entities of the sinonasal tract and nasopharynx is discussed. CONCLUSIONS: Misdiagnosing REAH or CORE hamartoma as either inverted papilloma or adenocarcinoma may lead to far more aggressive surgical intervention then is necessary.     

Das Hamartom

We present a case of a 44-year-old man with complaints of double-sided nasal obstruction and a foreign body sensation. A polypoid lesion was seen in the nasopharynx and was later completely excised. Histologic examination showed a respiratory epithelial adenomatoid hamartoma. The clinical and pathological features of this rare tumor as a cause of nasal obstruction are discussed.     

Respiratory epithelial adenomatoid hamartoma in the nasopharynx

We present a case report of a female patient with complaints of single-sided nasal obstruction. A polypoid structure was seen in the nasopharynx. Histologic examination showed a respiratory epithelial adenomatoid hamartoma -- a rare, benign lesion. Therapy consisted of complete excision. In line with previous reports, the lesion did not recur during 13 months of follow up. The clinical and pathological features of this abnormality are discussed.     

呼吸道上皮腺瘤样错构瘤

呼吸道上皮腺瘤样错构瘤（respiratory epithelial adenomatoid hamartoma,REAH）是一种非常少见的良性鼻腔鼻窦疾病。我们的课题组首先在国内报道该病,并多次报道该疾病,并且围绕REAH进行一系列研究及探讨。REAH并非罕见疾病,对该疾病的认识增加可提高该病的诊断率。现就REAH的病因、免疫学标记、诊断及治疗做一综述。     

Respiratory epitheloid adenomatoid hamartoma of the nasal cavity--case report and review of the literature

BACKGROUND: Hamartomas are tumour-like malformations, resulting from excessive proliferation of otherwise normal local tissue components. Hamartomas of the nasal cavity and paranasal sinuses are relatively rare, especially respiratory epithelial adenomatoid hamartomas. This benign lesion is characterized by a glandular proliferation originating from the surface of the respiratory epithelium. In the German speaking literature this entity has not been described before. PATIENT AND RESULTS: We report the case of a 51-year-old white female, presenting with a respiratory epithelial adenomatoid hamartoma of her left nasal cavity. The patient suffered from nasal obstruction. The CT scan showed a soft tissue like lesion obstructing the patient's left choana. After local resection of the tumour, which originated from the superior turbinate through functional endoscopic sinus surgery the patient's symptoms were gone. Follow-up after six months showed no evidence of recurrence. CONCLUSION: The histopathological differential diagnosis of respiratory epithelial adenomatoid hamartomas includes inverted papilloma and adenocarcinoma. Therefore the histological recognition of these hamartomas impacts on therapy. Misinterpretation as a true neoplasm may result in unnecessarily radical surgery. Local surgical resection is the treatment of choice for this lesion.     

Respiratory Epithelial Adenomatoid Hamartoma Originating from Nasal Septum

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign lesion in nasal cavity. We report two cases of REAH of the nasal cavity arising from nasal septum. The etiology of REAH is unknown although inflammation may induce gland proliferation observed in hamartomas. One of our cases was associated with nasal polyposis. REAH is a self-limiting disease, so it is important to differentiate REAH from other pathologic process, including inverted papilloma and low-grade adenocarcinoma. The treatment of choice is complete excision through a conservative approach.     

A case of respiratory epithelial adenomatoid hamartoma

We report a case of a 70-year-old man diagnosed with a respiratory epithelial adenomatoid hamartoma (REAH) of the nasal cavity after a past sinus surgery and associated with nasal polyposis. REAH is a recently described pathologic entity that can present with nasal obstruction, congestion, rhinorrhea, epistaxis, hyposmia, and headaches. It is a rare lesion of nasal and paranasal sinuses, but should be considered in the differential diagnosis because it is a benign lesion and complete surgical resection is curative.     

Respiratory epithelial adenomatoid hamartoma associated with inflammatory nasal polyposis: a case report

Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon benign lesion of the nasal cavity and paranasal sinuses. The etiology is unclear, however it is considered to be secondary to chronic sinonasal inflammation. Although it is rare, REAH should be taken into consideration in differential diagnosis of the nasal lesions. Complete surgical excision of the lesion is generally enough for the cure. A detailed pathological examination is necessary to prevent unnecessary surgical interventions. In this article, we present a 60-year-old female patient with REAH in the left nasal cavity associated with inflammatory polyp in the right nasal cavity.     

Chondro-osseous respiratory epithelial adenomatoid hamartoma of the nasal cavity: a case report

Chondro-osseous respiratory epithelial adenomatoid hamartoma (COREAH) of the nasal cavity is an exceedingly rare benign lesion of the nasal cavity. We report a case arising in an 11-year-old male patient, who presented with a 6-month history of right-sided nasal obstruction. Examination revealed a large fleshy, tender polyp in the right nasal cavity. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the large mass in the anterior nasal cavity extending superiorly to the cribriform plate on the right hand side. The polyp was resected endoscopically and confirmed histologically as a COREAH. The clinical differential diagnosis includes cartilaginous tumours and other hamartomatous lesions. Local resection should be curative.     

The importance of the differential diagnosis in rhinology: respiratory epithelial adenomatoid hamartoma of the sinonasal tract

IntroductionRespiratory epithelial adenomatoid hamartoma (REAH) is an uncommon lesion of the nasal and paranasal sinuses. It was first described in 1995 by Wenig and Heffner, and only about 60 cases have been published since then.Material and methodsWe present 6 case studies of nasal cavity hamartoma diagnosed and treated at our institution between 2005 and 2010. We also conducted a literature review and comprehensive study of the differential diagnosis of this condition, both clinical and pathological.ResultsThe male-female ratio was 5:1, with a mean age of 63.1 years. The most frequent symptoms were nasal obstruction, rhinorrhea and loss of smell. All cases were treated with endoscopic sinus surgery, without recurrences in the follow-up period (28.2 months; SD = 11.5 months).ConclusionWe suggest that differential diagnosis should be made on the basis of nasal polyps, antrochoanal polyps, inverted papilloma and low-grade adenocarcinoma. This review of published cases is of equal interest to both pathologists and otorhinolaryngologists.     

Endoscopic surgery of the olfactory cleft

The olfactory cleft is the specific site of development of many tumours (respiratory epithelial adenomatoid hamartoma, intestinal-type adenocarcinoma, neuroblastoma, inverted papilloma, glomangiopericytoma, etc.) and is also the site of CSF rhinorrhoea via the cribriform plate (cribri-rhinorrhoea). Olfactory cleft surgery must therefore be considered to be a specific type of surgery, complementary to ethmoidal labyrinth surgery and anterior skull base surgery. Olfactory cleft tumours can be resected according to five different surgical procedures: olfactory cleft mucosal resection, partial resection of the olfactory cleft, total resection of the olfactory cleft, unilateral endoscopic anterior skull base resection, and bilateral endoscopic anterior skull base resection. The diagnosis and closure of cribri-rhinorrhoea (i.e. documented CSF rhinorrhoea, demonstrated to arise from the cribriform plate during endoscopic examination of the olfactory cleft under general anaesthesia in a patient with no localizing signs on imaging) completes this range of treatment options.     

Respiratory epithelial adenomatoid hamartoma of bilateral olfactory clefts associated with nasal polyposis: Three cases report and literature review

We report three cases of patients with respiratory epithelial adenomatoid hamartoma (REAH) of bilateral olfactory clefts associated with nasal polyposis. REAH is a kind of rare lesion which commonly occurs in nasal cavity, paranasal sinuses, and nasopharynx. Our cases were all localized in bilateral olfactory clefts which is very rare since the most common site reported in the past in nasal cavity is the posterior nasal septum and unilateral. Furthermore, our presented cases all associated with nasal polyposis which can provide greater evidence that inflammation can induce REAH development. Although REAH is benign lesion it can probably continue developing after operation if REAH was not completely resected. So during endoscopic sinus surgery (ESS), complete resection of the lesions is key point in successfully treatment of REAH. Although REAH arising from the rhinosinusal region is very rare rhinolaryngologists should know this entity thoroughly in order to differentiate it from inverted papilloma and adenocarcinoma since misinterpretation of this lesion may result in aggressive surgery for a benign lesion which could greatly affect patient's quality of life after operation.     

Olfactory cleft dilatation

The surgical technique of olfactory cleft dilatation consists in transmucosal lateral fracture-dislocation of the lateral wall of each olfactory cleft (i.e., of the turbinate wall of the ethmoid, composed, from anterior to posterior, of the middle, superior and supreme turbinates), in order to get access to the recess hosting the human olfactory mucosa and to the roof of the olfactory cleft (i.e., cribriform plate), with minimal trauma to the mucosa. Olfactory cleft dilatation is indicated for dysosmia secondary to constitutional stenosis of the olfactory clefts due to abnormal development of the ethmoid. Constitutional stenosis of the olfactory clefts should be differentiated from inflammatory obstruction and other diseases of the olfactory clefts, and especially from respiratory epithelial adenomatoid hamartoma, which enlarges the olfactory clefts and must be treated by resection. The technique of olfactory cleft dilatation is illustrated by three surgical cases. There was clear improvement in dysosmia in all three cases, without any complications. The place of constitutional olfactory cleft stenosis needs still to be defined in both diagnosis and treatment of dysosmia.