Hamartomas, papillomas and adenocarcinomas of the sinonasal tract and nasopharynx

The sinonasal tract is a complex anatomic site, home to a wide variety of reactive, inflammatory, benign, and malignant lesions. Inflammatory polyps and papillomas are usually easily recognized by pathologists. A poorly understood lesion that has been more clearly defined in recent years is the nasal hamartoma. The epithelial subtypes include seromucinous hamartoma, respiratory epithelial adenomatoid hamartoma, and hybrid lesions. Seromucinous hamartomas have only been recognized and substantially reported over the past few years. They are a diagnostic challenge, needing to be distinguished from low grade adenocarcinomas, and are of interest because most of the basic questions about their pathophysiology remain unanswered. Herein, we present two novel cases of seromucinous hamartoma with features that partly expand the morphologic spectrum of these lesions, discuss the differential diagnosis, and review the literature to compare our findings with previously reported cases with the aim of better understanding this interesting entity.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Seromucinous Hamartoma of the Nasal Cavity: A Report of Two Cases and Review of the Literature

Khan

Chernock

Lewis

2011

“…Most of these consist of inflammatory polyps, papillomas and squamous cell carcinomas [1]. Other diagnoses such as salivary type tumors, olfactory neuroblastomas and poorly differentiated carcinomas may occasionally be seen but are familiar to most surgical pathologists.…”

Section: Introductionmentioning

confidence: 99%

Low Grade Glandular Lesions of the Sinonasal Tract: A Focused Review

Weinreb

2010

The sinonasal tract is a complex anatomic site with an exhaustive list of possible diagnoses. While most biopsies or resections encountered routinely consist of common diagnoses such as inflammatory polyps and papillomas, occasional cases are more difficult, and separating reactive or benign from malignancy can be challenging. One of the most poorly understood and daunting categories is low grade glandular or tubular proliferations, particularly on small biopsies. Possible diagnoses such as reactive lesions, respiratory epithelial adenomatoid hamartoma (REAH), seromucinous (glandular) hamartoma (SH) and low grade sinonasal adenocarcinomas (LGSNAC) must be entertained. REAH is composed of respiratory epithelial lined submucosal glands with variable connection to the surface and periglandular hyalinization. SH is a tubular proliferation reminiscent of normal serous glands which may be associated with REAH.LGSNAC is a diverse group of bland tubular and/or papillary tumors, which have a recurrence potential but an as yet uncertain potential for metastasis or mortality. The management for these lesions can be vastly different and conservative management is preferable, making this distinction more than academic. However, complicating this category are controversies surrounding their nature as reactive lesions versus neoplasms, the histologic and immunohistochemical overlap, and possible precursor relationships between some of them.

“…The clinical and morphological features of each are quite distinct, and although some overlap exists, they should not be lumped together for diagnostic purposes as ''Schneiderian papilloma'' without further qualification. The etiology of FSP and ISP has long been thought to be human papillomavirus infection, particularly with low risk HPV serotypes 6 and 11 [2,[4][5][6]. HPV DNA has been identified, using various techniques and combining the results of several studies, in approximately one third of papillomas [5].…”

Section: Schneiderian Papillomas Backgroundmentioning

confidence: 99%

Low-Grade Epithelial Proliferations of the Sinonasal Tract

Bullock

2016

Low-grade epithelial proliferations of the sinonasal tract include Schneiderian papillomas, respiratory epithelial adenomatoid hamartoma, seromucinous hamartoma and low-grade non-intestinal adenocarcinoma. There is considerable overlap in their clinical presentation, endoscopic appearance, and imaging features. Although well-described diagnostic criteria exist, a definitive diagnosis may be difficult to reach on a small biopsy. Schneiderian papillomas are divided into fungiform, inverted, and oncocytic types, each with characteristic clinical and morphological features. The latter two may progress to malignancy. The majority are still considered to be HPVrelated. Two lesions are designated as hamartomas, but their pathogenesis remains uncertain, with inflammatory and neoplastic origins proposed. Respiratory epithelial adenomatoid hamartoma is increasingly being recognized for its association with chronic rhinosinusitis and olfactory cleft site of origin. Seromucinous hamartoma has gained attention in recent years and overlaps with both respiratory epithelial adenomatoid hamartoma and low-grade non-intestinal adenocarcinoma. Controversy surrounds their distinction, particularly from low-grade adenocarcinoma. The latter generally is cured by complete excision, with a 26 % risk of recurrence but rare metastases and deaths from disease.