RESPIRATORY EPITHELIAL ADENOMATOID HAMARTOMA OF THE MIDDLE MEATUS MASQUERADING AS A SINONASAL MALIGNANCY: A CASE REPORT

Abstract

Introduction: Respiratory Epithelial Adenomatoid Hamartoma (REAH) is a rare, benign lesion of the upper respiratory tract that primarily affects the nasal cavity and paranasal sinuses. What makes REAH particularly unique and what it adds to the scientific literature is its tendency to be misdiagnosed as an inflammatory polyp, an inverted papilloma, or a frank sinonasal malignancy due to its gross, radiological, and histological resemblances to these pathologies.

Main Symptoms and Clinical Findings: A 55-year-old male presented with a 6-month history of right-sided nasal obstruction. Nasal endoscopy revealed a large, well-circumscribed, whitish polypoidal lesion arising from the middle meatus, accompanied by foul-smelling and mucopurulent discharge.

Main Diagnoses, Therapeutic Interventions, and Outcomes: Pre-operative contrast-enhanced computed tomography (CECT) imaging suggested a neoplastic etiology due to bone sclerosis and pressure erosions. An initial biopsy suggested an inflammatory polyp. The patient underwent endoscopic sinus surgery for definitive excision. Final histopathological examination confirmed a diagnosis of REAH.

Conclusion: REAH is a benign malformation that is frequently misdiagnosed as a malignant tumor due to clinical and radiological similarities. Accurate recognition through histopathological evaluation is essential to avoid unnecessarily aggressive and mutilating surgical treatments or adjuvant therapies.