Adenomatoid Hamartoma

Respiratory epithelial adenomatoid hamartoma (or polypoid hamartomas) typically arises within the nasal cavity and paranasal sinuses (see also Chap. 2), but has also been reported in the nasopharynx [199]. Patients are adults with an age range of 24-81 years. The polypoid exophytic hamartomas are rubbery, tan to brown and can reach up to 6 cm in size. They are lined with ciliated respiratory epithelium with mucin-secreting goblet cells. The widely spaced glandular proliferations arise from invagination of the surface epithelium. A thick eosinophilic basement membrane surrounds the glands and surface epithelium. The ample stroma may be oe-dematous and well-vascularised or fibrous with varying amounts of lymphocytes and inflammatory cells (Fig. 6.4). Glandular acinar proliferations may be scant and large cysts may predominate when the fibrous stro-ma predominates [206]. Some nasopharyngeal hamar-tomas include a chondro-osseous component and cysts lined with squamous epithelium. Due to overgrowth of a single mesenchymal element, respiratory epithelial adenomatoid hamartomas may resemble fibromas, lipomas or chondromas [199]. Treatment of choice is surgery. The differential diagnoses of respiratory epithelial adenomatoid hamartoma include inverted papilloma and adenocarcinoma. The presence of excess glands and the respiratory epithelium distinguish the hamartoma readily from an inverted papilloma. The lack of malignant cytological and histological features and invasion distinguishes the respiratory epithelial adenomatoid hamartoma from an adenocarcinoma.

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