Respiratory epithelial adenomatoid hamartomas

Abstract

The aim of this study was to understand the definition of respiratory epithelial adenomatoid hamartoma (REAH) and the association between REAH and chronic sinusitis and nasal polyposis, and to describe the histology and management of REAH. Retrospective review. This retrospective review in a tertiary academic medical center studied patients with findings of REAH after endoscopic sinus surgery over a 10-year period. Age, sex, location, associated findings, radiographic features, and recurrences were reviewed. There were 54 patients with REAH identified who underwent endoscopic sinus surgery between January 2000 and May 2011. The ratio of disease between males and females was equal, and the average age at diagnosis was 52 years. Although the majority of cases had findings of REAH within the sinuses, eight (15%) were present as isolated masses within the nasal cavity. Available preoperative computed tomography scans were reviewed (n = 35), revealing no distinguishing features confirming REAH. Twenty-four cases (44%) were associated with an allergic type of chronic sinusitis and nine (17%) were associated with nasal polyposis. There were two (3.7%) recurrences, with no recurrences following repeat surgery. The average follow-up was 3.8 years. REAH is a benign entity characterized by abnormal glandular proliferation of the surface ciliated respiratory epithelium, admixed with goblet cells with no atypia or metaplastic change, rimmed by a thick basement membrane. It can present as an isolated mass within the nasal cavity or as an incidental finding in patients with chronic sinusitis. Nasal polyposis and allergic sinusitis can also be associated with REAH. Recurrences are rare with complete excision being essentially curative.