Baylor University Medical Center Proceedings April 2017 - 221

Bilateral respiratory epithelial adenomatoid hamartomas
originating from the anterior olfactory clefts
Jeffrey J. Falco, BS, Brandon S. Peine, BS, and David W. Clark, MD

A respiratory epithelial adenomatoid
hamartoma (REAH) is an uncommon
benign lesion often found in the sinonasal tract. We present a case of bilateral REAH originating from the anterior
olfactory cleft treated with endoscopic
surgical resection without recurrence.
We highlight the characteristics of REAH
and necessary steps to ensure proper
diagnosis and treatment.

respiratory epithelial adenomatoid hamartoma (REAH)
is a hamartoma arising from
the nasal cavity, paranasal sinuses, or nasopharynx (1). REAH
was ﬁrst described in 1995 by Wenig
and Heﬀner (2). Since then, at least Figure 1. (a) Coronal and (b) sagittal T1 postcontrast MRI of the paranasal sinuses demonstrating bilateral enhancing
polypoid lesions in the anterior olfactory cleft.
394 cases of REAH have been reported, with a 3:2 male-to-female ratio (3). REAH displays
than left. Magnetic resonance imaging (MRI) of the skull base
distinct histopathological features characterized by polyps with
demonstrated heterogeneity of the mass with enhancement,
pseudoglandular proliferation lined by ciliated respiratory epiﬁndings not suggestive of simple nasal polyposis (Figure 1). The
thelium (4). The etiology of REAH is unknown and appears to
patient was taken to the operating room and underwent endobe multifactorial (4). Most reports indicate that REAH occurs
scopic resection of the lesions. Both lesions had lateralized the
in the presence of sinonasal inﬂammation (1-3, 5, 6). Presenting
middle turbinate, allowing direct access and complete removal
signs and symptoms include nasal obstruction, nasal congestion,
endoscopically without complications. The lesions appeared to
deviated septum, epistaxis, rhinorrhea, chronic sinusitis, facial
be ﬁbrous polyps on gross examination and were easily resected
pain, headache, and olfactory dysfunction (7, 8). Complete surwith Blakesley forceps. Approximately 20 cc of blood loss ocgical resection is the preferred treatment (8). We present a case
curred during the resection. Histologically, both right and left
of bilateral REAH originating from the anterior olfactory clefts.
nasal contents revealed inﬂamed polypoid fragments of respiratory mucosa with features consistent with REAH (Figure 2). At
CASE DESCRIPTION
2- and 14-month follow-up, there was no recurrence of REAH
A 75-year-old man was referred to the otorhinolaryngology
bilaterally, as veriﬁed by diagnostic endoscopy, and our patient
department due to anosmia. He reported 10/10 loss of sense of
smell that began in the early 1990s. He denied additional nasal
From the Department of Otolaryngology-Head & Neck Surgery, Baylor Scott &
symptoms. His medical history was signiﬁcant for progressive
White Health, Temple, Texas (Clark) and Texas A&M Health Science Center College
dementia, coronary artery disease, and a cerebrovascular acof Medicine (Falco, Peine, Clark).
cident 3 years prior.
Corresponding author: David W. Clark, MD, Department of Otolaryngology-Head
Diagnostic endoscopy revealed bilateral masses in both the
& Neck Surgery, Baylor Scott & White Health, 2401 South 31st Street, Temple,
TX 76508 (e-mail: David.Clark1@BSWHealth.org).
right and left anterior olfactory clefts, with a larger right mass
Proc (Bayl Univ Med Cent) 2017;30(2):221-223

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