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

Respiratory epithelial adenomatoid hamartoma (REAH) is a relatively recent diagnosis that is gaining more interest in sinus surgery. REAH of the olfactory cleft was often misdiagnosed, and interpreted as nasal polyposis (NP). We present a retrospective case series of 27 patients who were diagnosed and treated for REAH of the olfactory cleft, in the past 7 years, in our department. The aim of this study is to present the diagnostic modalities and the results and follow-up after surgery. The male to female ratio was 2.9:1, with a mean age of 56 years. Almost half of these patients were operated at least once before on their sinuses. The most common presenting symptoms of isolated REAH are olfactory disorders. All cases were treated surgically with endoscopic sinus surgery, without recurrences in the follow-up period. Knowledge and identification of REAH of the olfactory cleft are fundamental. Knowledge, identification, and adequate treatment of these lesions are fundamental, as they limit the number of recurrences.

Our experience with respiratory epithelial adenomatoid hamartomas of the olfactory cleft

Resumen Introduccion El Hamartoma respiratorio adenoepitelial (HRA) es una lesion poco comun de la nariz y los senos paranasales caracterizada por la formacion anormal de tejido glandular. Fue descrita por primera vez por Wenig y cols., en 1995 y, desde entonces, tan solo se ha publicado unos 60 casos. Material y metodos En este trabajo, presentamos el estudio de seis casos de hamartoma de cavidad nasal, los cuales fueron diagnosticados y tratados en nuestro Centro entre los anos 2005 y 2010. Asimismo, realizamos un estudio completo del diagnostico diferencial de esta patologia, tanto a nivel clinico como anatomopatologico. Resultados En estos pacientes, la razon hombre:mujer fue 5:1, con una media de edad de 63,1 anos (DE = 16,9). Todos los sujetos presentaron afectacion de la fosa nasal y, en tres casos, ocupacion de los senos maxilar, frontal y etmoidal. Los sintomas mas frecuentes fueron obstruccion nasal, rinorrea y perdida de olfato. Todos los casos fueron tratados mediante cirugia endoscopica nasosinusal sin evidencia de recirrencia en el periodo de seguimimento (28,2 meses, DE = 11,5). Las caracteristicas mas importantes del HRA son: edema estromal, proliferacion glandular seromucosa, proliferacion fibroblastica y vascular, infiltrado inflamatorio mixto, incremento de la proliferacion adenomatoide, acumulo de material glandular y cambios atroficos del epitelio. Conclusion Sugerimos que el diagnostico diferencial debe realizarse con la poliposis nasosinusal, polipo antrocoanal, papiloma invertido y adenocarcinoma. Un diagnostico incorrecto podria dar lugar a un tratamiento demasiado agresivo. Esta revision de los casos publicados, con enfasis en el diagnostico diferencial es de interes tanto para otorrinolarigologos como anatomopatologos.

Importancia del diagnóstico diferencial en rinología: hamartoma respiratorio adenoepitelial

Introduction Respiratory 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 methods We present six 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. Results The 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). Conclusion We 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.

The Importance of the Differential Diagnosis in Rhinology: Respiratory Epithelial Adenomatoid Hamartoma of the Sinonasal Tract

Renal cell carcinoma is one of the most common tumours to spread by extranodal metastases to the head and neck. Metastatic renal cell carcinoma to the head and neck area has been demonstrated mostly in the paranasal sinuses, parotid gland, the mandible, larynx and hypopharinx. Renal cell carcinoma should be excluded whenever a metastatic lesion is encountered in the head and neck area, even if the metastatic lesion is the first clinical presentation. The diagnosis of metastatic RCC should be suspected in any patient with even a remote history of renal cell carcinoma. We report a case of 79 year old woman with recurrent episodes of rhinorrhea, headache, hyposmia and monolateral right epistaxis, with a history of RCC. We describe RCC nasal metastases in a metachronous bilateral neoplasm, in which a second occult lesion debuted with a homolateral nasal metastases, ten years after left nephrectomy.

Nasal metastasis as the first manifestation of a metachronous bilateral renal cell carcinoma.

We report a case of a 29-year-old male patient with a respiratory epithelial adenomatoid hamartoma (REAH) of the nasal cavity. REAH is a polypoid proliferation of glandular spaces lined by ciliated epithelium and goblet cells in the upper aerodigestive tract. Although REAHs are benign lesions, they may be confused with a variety of other pathologies such as inflammatory polyps, inverted Schneiderian papillomas and low-grade sinonasal adenocarcinomas. The recognition of this entity is important as complete excision is curative.

Respiratory epithelial adenomatoid hamartoma: case report and literature review.

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Respiratory epithelial adenomatoid hamartoma: case report and literature review.