A Rarely Seen Mass of Nasal Cavity: Seromucinous Hamartoma

Abstract

Seromucinous hamartoma (SH) is a rarely seen benign polypoid mass of the sinonasal tract. Although the most common presentation symptom is nasal obstruction, most of the patients are asymptomatic. In this paper, the authors present an additional case of SH and discuss its differential diagnosis. A 34-year-old male patient presented with progressive nasal obstruction and serous nasal discharge for several months. A well-defined polypoid mass was detected in the left nasal cavity during the endoscopic assessment. Preoperative biopsy was reported as benign polypoid lesion. The mass was resected via transnasal endoscopic approach and final pathological examination was notified as SH. The SH is an uncommon tumor, originates from nasal septum in the most cases and presents as a well-circumscribed polypoid mass. Radiological imaging modalities and biopsy should be performed to distinguish from the sinonasal malignancies. Complete surgical excision is recommended treatment and recurrence is almost never.

Middle Turbinate Seromucinous Hamartoma in a Patient With Primary Atrophic Rhinitis

“…1,2 Only 39 cases of SH have been previously described in the literature. [1][2][3][4][5] The male to female ratio is 3:2. 1 The most common symptoms are nasal obstruction, mucopurulent secretion, and epistaxis.…”

“…It is unclear whether these lesions are true benign neoplasms or developmental tumor-like lesions. [1][2][3][4][5] According to the 4th edition of the World Health Organization Classification of Head and Neck Tumors, SH and respiratory epithelial adenomatoid hamartoma (REAH) are classified as ''respiratory epithelial lesions.'' 6 The differential diagnosis for SH includes inflammatory nasal polyps, REAH, and low-grade sinonasal adenocarcinoma (LGSNA).…”

“…Seromucinous hamartoma is characterized by numerous seromucinous glands, which are not present in inflammatory polyps. [1][2][3][4][5] The stroma of inflammatory polyps is more edematous and the surface is smooth. 1 REAH is the most common hamartoma in the sinonasal tract, characterized by proliferation of pseudostratified respiratory epithelium-lined pseudoglands.…”

“…1,5 On the other hand, SH is characterized by the presence of true, single-layered seromucinous glands. [1][2][3][4][5] Low-grade sinonasal adenocarcinoma shows the presence of back-to-back glands with pleomorphisms, mitoses, anisocytosis, and cell hyperchromasia, and without a rich stroma. It usually grows in a papillary or cribriform pattern and may invade nearby normal structures.…”

“…5 Transnasal endoscopic resection is currently the standard management for all sinonasal hamartomas. [1][2][3][4][5] The role of chronic inflammation in the growth of SH has also been considered. In addition to being associated with REAH, SH can also be associated with chronic inflammatory diseases of the sinonasal mucosa, especially with chronic rhinosinusitis with and without nasal polyps.…”