Huge Respiratory Epithelial Adenomatoid Hamartoma Originating from the Inferior Nasal Turbinate: A Case Report

Abstract

Respiratory epithelial adenomatoid hamartoma (REAH) is a recently described entity consisted of benign glandular proliferations lined by pseudostratified respiratory epithelium. We report a case of a 22-year-old male patient with 7-year history of nasal obstruction and headache resulting from a huge left-sided nasal lesion. Computed tomography, magnetic resonance and biopsy were performed to make a provisional diagnosis of REAH originating from the left-sided inferior turbinate. The definitive diagnosis of REAH was made by histopathological examination of the removed mass. We also discuss the origin and differential diagnosis of these rare lesions.

Seromucinous hamartoma of inferior turbinate

“…[ 2 , 4 ] Adenocarcinomas show crowded glandular proliferations, pleomorphism, mitoses, and varying degrees of cellular atypia. [ 5 ] However, histological distinction is sometimes difficult if the biopsy sample is too small, as was the case with our patient.…”

“…[ 1 – 4 ] The etiology of hamartoma is unknown, but chronic inflammation of the nasal mucosa associated with chronic rhinosinusitis, allergic rhinitis, or bronchial asthma is the most accepted hypothesis. [ 5 ] The lesion occurs predominantly in women, and the most common symptom is unilateral nasal obstruction, followed by nasal bleeding. [ 1 – 4 ] The majority of these lesions occurred in either the posterior nasal cavity or the nasopharynx, and most have occurred from the posterior nasal cavity medial to the middle turbinate.…”

“…[ 3 , 4 ] These lesions have similar clinical presentations and histopathologic and immunohistochemical features. [ 1 – 5 ] In addition, there are no criteria for definitive distinction between these lesions. [ 4 ]…”

“…However, distinguishing between benign hamartoma and adenocarcinoma is important because benign tumors have rarely been reported to recur, unlike adenocarcinomas. [ 1 – 5 ] Unlike respiratory epithelial adenomatoid hamartomas, seromucinous hamartomas consist of epithelial proliferations of mixed small and large glands. [ 2 , 4 ] Adenocarcinomas show crowded glandular proliferations, pleomorphism, mitoses, and varying degrees of cellular atypia.…”

“…[ 1 – 4 ] Distinguishing between benign hamartoma and adenocarcinoma is important because benign tumors have rarely been reported to recur. [ 1 – 5 ] Seromucinous hamartoma is a rare benign glandular proliferation of the sinonasal tract and nasopharynx, and the majority of lesions occur on the posterior nasal septum. [ 1 – 4 ] Herein, we report an unusual case of a patient with seromucinous hamartoma at the anterior end of the right inferior turbinate that was mistaken for low-grade, non-intestinal-type adenocarcinoma.…”