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An 80-year-old man with acromegaly due to a hypoenhancing pituitary microadenoma opted for transsphenoidal resection. Preoperative magnetic resonance imaging examination of the sella revealed a left-sided pituitary microadenoma (Figure, A) and lobulated polypoid soft tissue masses in the superior nasal cavities arising from the olfactory clefts. These lesions demonstrated avid post–contrast enhancement with small areas of cystic change and heterogeneously hyperintense T2 signal. There was mild widening of the olfactory clefts, particularly on the left side (Figure, B). The intervening nasal septum was intact, and there was no intracranial extension. The patient did not have any noteworthy rhinological symptoms on review. He later underwent nasal endoscopy, and results showed tan-colored polypoid lesions emanating from the olfactory clefts of both nasal cavities (Figure, C). Biopsy findings revealed submucosal proliferation of seromucinous and respiratory epithelial glands (Figure, D).
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D. Nasal cavity hamartoma
There are 2 types of sinonasal hamartomas identified on histopathologic analysis: respiratory epithelial adenomatoid hamartoma (REAH) and seromucinous hamartoma. The latter of these is included as a new entity in the fourth edition of WHO Classification of Head and Neck Tumours.1 These lesions are described as respiratory epithelial lesions in the current classification. It is difficult to differentiate the 2 types using histopathologic, endoscopic, or imaging analysis, and they are believed to represent a spectrum. Recently, a possible new subtype containing olfactory neuroepithelial cells was also described.2 It is still unclear whether these sinonasal lesions represent nonneoplastic lesions (hamartomas) or true benign neoplasms. Ozolek and colleagues3 demonstrated significant allelic loss in REAH, which raises the possibility of these being true neoplasms.
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Corresponding Author: Joseph H. Donahue, MD, Department of Neuroradiology, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22908 (firstname.lastname@example.org).
Published Online: May 16, 2019. doi:10.1001/jamaoto.2018.3983
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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