Lin Yu-Wen, Lai Kuan-Ju, Shen Kuang-Hsuan
Department of Otolaryngology Head and Neck Surgery, Mackay Memorial Hospital, Taitung, Taiwan.
Department of Otolaryngology Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan.
Ear Nose Throat J. 2025 Mar;104(3):NP134-NP138. doi: 10.1177/01455613221101936. Epub 2022 May 9.
Hamartomas are common in the lung, kidney, liver, spleen, and, but rare, in the sinonasal tract. Respiratory epithelial adenomatoid hamartomas (REAHs) are benign lesions common in men aged 30 to 90 years. Approximately 70% of REAHs in the head and neck region originate from the posterior nasal septum. We present an unusual case of REAH originating from the maxillary sinus and extending to the nasopharynx of an adolescent boy.A 17-year-old boy without any salient medical history presented to our department with nasal obstruction that had persisted for 7 years as well as greenish nasal discharge, hyposmia, and a complaint of fetid smell. Sinoscopy of the osteomeatal complex (OMC) revealed bilateral mucopus and a large right polypoid tumor extending into the nasopharynx. Computed tomography of the paranasal sinuses revealed soft-tissue opacification around the right OMC, frontal sinus, ethmoid sinus, maxillary sinus, and nasopharynx. We performed bilateral endoscopic sinus surgery. REAH and chronic rhinosinusitis with nasal polyps were diagnosed on the basis of a pathology report. No evidence of recurrence was observed by 6 months after surgery, and his hyposmia, nasal obstruction, and purulent nasal discharge were alleviated considerably. Accurate diagnosis based on pathology is essential for determining the optimal treatment, which for REAH is complete surgical excision.
错构瘤在肺、肾、肝、脾中较为常见,但在鼻窦中罕见。呼吸道上皮腺样错构瘤(REAHs)是常见于30至90岁男性的良性病变。头颈部区域约70%的REAHs起源于后鼻中隔。我们报告一例罕见的REAH病例,该病例起源于一名青少年男孩的上颌窦并延伸至鼻咽部。一名无显著病史的17岁男孩因鼻塞7年、伴有绿色鼻分泌物、嗅觉减退及恶臭感前来我科就诊。鼻窦开口复合体(OMC)的鼻窦镜检查显示双侧有黏液脓性分泌物,右侧有一个大的息肉样肿瘤延伸至鼻咽部。鼻窦计算机断层扫描显示右侧OMC、额窦、筛窦、上颌窦及鼻咽部周围有软组织混浊。我们进行了双侧鼻内镜鼻窦手术。根据病理报告诊断为REAH和慢性鼻窦炎伴鼻息肉。术后6个月未观察到复发迹象,其嗅觉减退、鼻塞及脓性鼻分泌物均有明显缓解。基于病理的准确诊断对于确定最佳治疗方案至关重要,REAH的最佳治疗方案是完整手术切除。