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Clinical Note |

Bilateral Olfactory Fossa Respiratory Epithelial Adenomatoid Hamartomas

Jean Anderson Eloy, MD; Mark E. Friedel, MD; Jean Daniel Eloy, MD; Neena M. Mirani, MD; James K. Liu, MD
Arch Otolaryngol Head Neck Surg. 2011;137(8):820-822. doi:10.1001/archotol.137.8.820.
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Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign nonneoplastic sinonasal lesion that usually presents unilaterally. We report an unusual case of bilateral olfactory fossa REAHs mimicking an olfactory neuroblastoma that originated from the superior aspect of the middle turbinates. To our knowledge, only 1 similar case has been reported to date. Rhinologists and skull base surgeons should be aware of this rare entity to prevent unnecessary radical surgical interventions. Complete removal can be performed using a minimally invasive endonasal endoscopic approach.

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Figure 1. Coronal computed tomogram shows bilateral olfactory fossa masses (white arrows) with mild to moderate lateralization of the middle turbinates (black arrows).

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Figure 2. Magnetic resonance images of bilateral respiratory epithelial adenomatoid hamartomas. Axial (A) and coronal (B) T1-weighted fat-suppressed gadolinium-enhanced images of the paranasal sinuses showing bilateral enhancing soft-tissue lesions in the olfactory recesses. Axial (C) and coronal (D) T2-weighted images show hyperintense bilateral olfactory fossa lesions without intracranial extension.

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Figure 3. Intraoperative right (A) and left (B) endoscopic views showing bilateral polypoid lesions in the olfactory recesses (long white arrows), with lateral displacement of the middle turbinates (black arrows). The lesion was abutting but easily separated from the nasal septum (wide white arrows).

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Figure 4. Photomicrographs of bilateral respiratory epithelial adenomatoid hamartomas. A, The glands are seen in continuity with the surface epithelium. The stroma is well vascularized, edematous, and fibrous and contains scattered chronic inflammatory cells (hematoxylin-eosin, original magnification ×100). B, The glands are lined by ciliated respiratory epithelium with goblet cells and characteristically surrounded by a thick, eosinophilic basement membrane (hematoxylin-eosin, original magnification ×400).

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