Hamartoma Epithelial Respiratory Adenomatoid- Literature Review

Hamartoma (from the Greek, Hamartia, meaning fault or defect) is used to describe an overgrowth of normal mature cells and tissues indigenous to the area of its occurrence. It may occur in any organ of the body. Wenig and Heffner described a series of 31 cases of Respiratory Epithelial Adenomatoid Hamartoma (REAH) from what they considered a benign neoplasm. Today the most acceptable hypothesis is that REAH is a hyperplasia of the respiratory epithelium induced by a local chronic inflammation. Since its publishing, 394 cases of the disease have been described and REAH was found in 35-48% of patients operated on for nasal polypose. Some authors believe that REAH is the most important differential diagnosis of nasal polypose. REAH can be observed in two forms: isolated REAH (less frequent) or in association with another inflammatory process. The location in the olfactory cleft is concisely described in literature. Patients with REAH exhibit similar symptoms to those with chronic nasal inflammatory diseases. Endoscopy usually reveals a mass with a slight cerebriform aspect, fleshy to firm, pinkish or sometimes yellowish. The mass typically emerges from the cleft between the nasal septum superior-anterior and the middle turbinates, with a lateralization of the middle turbinates. Computed tomography (CT) scan is essential to diagnosis suspicion, which is increased by a CT scan that shows opacified and widened olfactory clefts. The conclusive diagnosis is only made by biopsies. Surgical treatment of the olfactory cleft is reported to be curative for REAH and the literature have also not described any recurrence or malignization. The knowledge of this lesion, mostly underdiagnosed, will allow the correct and necessary treatment that it takes.

Keywords: Respiratory ephitelial adenomatoid hamartoma; REAH; Differential diagnosis; Nasal polypose