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Michal M, Skálová A, Hyrcza M, Laco J, Vaněček T, Rupp NJ, Michal M, Michalová K, Agaimy A, Bradová M. Nasal and sinonasal tumors formed by atypical adenomatous lesions arising in respiratory epithelial adenomatoid hamartoma/seromucinous hamartoma. Virchows Arch 2024; 485:31-42. [PMID: 38087091 DOI: 10.1007/s00428-023-03719-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/26/2023] [Accepted: 12/04/2023] [Indexed: 07/20/2024]
Abstract
Two benign adenomatous lesions are commonly recognized within the sinonasal tract, namely respiratory epithelial adenomatoid hamartoma (REAH) and seromucinous hamartoma (SH). We present 10 hitherto unrecognized benign polypoid nasal and sinonasal tumoriform lesions having in average 3.6 cm in largest dimension, which are histogenetically related to SH and REAH. In addition to typical structures of REAH and SH, these lesions contained an additional characteristic and slightly atypical adenomatous component, which we termed atypical sinonasal glands arising in SH (ASGSH). ASGSH often produced deep red colored secretion with peripheral clearing similar to that seen in thyroid follicles. In contrast to SH, ASGSH was endowed by both secretory and myoepithelial layers and had mostly angulated shapes with snout-like protrusions into the lumens. Both layers were formed by an irregular, disorganized, and often incomplete cell lining, which had slightly atypical cytological features without mitoses. In 3 cases, ASGSHs revealed sebaceous differentiation, and in 3 cases the stroma produced a well-differentiated cartilage. Neoplastic nature of ASGSH was supported by finding of various mutations as revealed by next generation sequencing in five cases. In two cases each, we found identical mutations in BRAF gene (Val600Glu), and RET gene (Arg912Trp), respectively and in one case FAT1 gene alteration (Pro1665Leu).
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Affiliation(s)
- Michal Michal
- Sikl's Department of Pathology, Faculty of Medicine in Plzen, Charles University, and University Hospital, E. Benese 13, 305 99 Pilsen , Plzen, Czech Republic
- Bioptic Laboratory, Ltd, Plzen, Czech Republic
- Cytopathos, Ltd., Bratislava, Slovak Republic
| | - Alena Skálová
- Sikl's Department of Pathology, Faculty of Medicine in Plzen, Charles University, and University Hospital, E. Benese 13, 305 99 Pilsen , Plzen, Czech Republic
- Bioptic Laboratory, Ltd, Plzen, Czech Republic
| | - Martin Hyrcza
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Jan Laco
- The Fingerland Department of Pathology, Faculty of Medicine, Charles University, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Michal
- Sikl's Department of Pathology, Faculty of Medicine in Plzen, Charles University, and University Hospital, E. Benese 13, 305 99 Pilsen , Plzen, Czech Republic
- Bioptic Laboratory, Ltd, Plzen, Czech Republic
| | - Květoslava Michalová
- Sikl's Department of Pathology, Faculty of Medicine in Plzen, Charles University, and University Hospital, E. Benese 13, 305 99 Pilsen , Plzen, Czech Republic
- Bioptic Laboratory, Ltd, Plzen, Czech Republic
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University of Erlangen-Nuremberg, University Hospital of Erlangen, Erlangen, Germany
| | - Martina Bradová
- Sikl's Department of Pathology, Faculty of Medicine in Plzen, Charles University, and University Hospital, E. Benese 13, 305 99 Pilsen , Plzen, Czech Republic.
- Bioptic Laboratory, Ltd, Plzen, Czech Republic.
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Hu C, Liu Y, Lin L, Yuan C, Ma D, Huang Q. Pathogenic Somatic Mutation of DICER1 and Clinicopathological Features in Nasal Chondromesenchymal Hamartomas: A Series of Nine Cases. Am J Surg Pathol 2024; 48:588-595. [PMID: 38357912 DOI: 10.1097/pas.0000000000002192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Nasal chondromesenchymal hamartoma (NCMH) is a rare benign polypoid mesenchymal tumor arising in the nasal cavity and/or paranasal sinuses. Recognizing these sporadic, rare lesions is crucial, as surgical complete removal of the mass is the common treatment approach. This retrospective study analyzed the demographics, symptoms, and imaging data of 9 patients diagnosed with NCMH between January 2017 and June 2023, possibly representing the largest single-center adult case cohort to date. Diagnostic techniques included nasal endoscopy, CT/MRI scan, immunohistological studies, and morphologic comparisons. Pathologic specimens were subjected to Sanger sequencing of exons 24 and 25 of DICER1. The average age of 9 cases was 24.4 years, and the oldest was 55 years. Four of the patients were children, ranging from 1 year old to 11 years old, with an average of 4.5 years. Nasal congestion is the most common registered symptom. Endoscopic findings showed that most patients had smooth pink neoplasms or polypoid masses in the nasal meatus. Radiologic scanning revealed soft-tissue density masses that occupied the nasal cavity. Histologically, the characteristic structure of NCMHs is immature cellular cartilage nodules and mature cartilage nodules distributed in a loose mucoid matrix. Five of the 9 patients had somatic DICER1 missense mutations. Four of the patients with DICER1-mutated NCMH exhibited a p.E1813 missense hotspot mutation. We also report a case of a rare p.P1836H missense mutation. The detected DICER1 somatic mutations provide compelling evidence of an association with the DICER1 tumor family. We emphasize the importance of pathologic consultation and the need for pathologists to accumulate experience in NCMH diagnosis to avoid misdiagnosis.
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Affiliation(s)
- Chunyan Hu
- Department of Biochemistry and Molecular Biology, Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yifeng Liu
- Department of Pathology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Lan Lin
- Department of Pathology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Cuncun Yuan
- Department of Pathology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Duan Ma
- Department of Biochemistry and Molecular Biology, Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Qiang Huang
- Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
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Yang Q, Han F, Jiang L, Wang S, Zhang J, Zhao J, Xu Y. [Neonatal cervical chondromesenchymal hamartoma: a case report and literature review]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2024; 38:339-342. [PMID: 38563180 PMCID: PMC11387294 DOI: 10.13201/j.issn.2096-7993.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Indexed: 04/04/2024]
Abstract
Cartilage mesenchyme hamartoma originates from the mesoderm and contains a blend of interstitium and cartilage, which is mostly benign tumor and is a non-neoplastic cartilage lesion with self-limiting hyperplasia. This article reports a infant with cervical chondromesenchymal hamartoma in the neck, the main clinical manifestations of which are asphyxia and acute respiratory distress, and the imaging features are often similar to those of malignant tumors.Radical resection operation under general anesthesia is the main treatment method, and the postoperative pathological diagnosis was cartilage mesenchyme, and immunohistochemistry showed Catenin(-),MDM2(+),CDK4(-),H3K36M(+),Myogenin (-),SMA (-).The clinical characteristics and diagnosis and treatment process of this case are reported and related literature is reviewed.
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Affiliation(s)
- Quyang Yang
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital Affiliated of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450003, China
| | - Fugen Han
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital Affiliated of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450003, China
| | - Lan Jiang
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital Affiliated of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450003, China
| | - Shengcai Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Jie Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital Affiliated of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450003, China
| | - Jing Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Ying Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital Affiliated of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450003, China
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Patel N, Server M, Bayoumi A, Ezzat Ibrahim A. Nasal Glial Hamartoma: A New Type of Sinonasal Hamartomas. Cureus 2024; 16:e52781. [PMID: 38389633 PMCID: PMC10882638 DOI: 10.7759/cureus.52781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Hamartomas are rare, tumour-forming, benign lesions that have been reported throughout the body that can resemble other malignant entities. Hamartoma subtypes can be distinguished based on their histological features. Sinonasal hamartomas may have presenting symptoms and radiological features that mimic other nasal neoplastic lesions. Therefore, it is essential to diagnose it accurately, as the treatment approaches can range from radical surgeries in malignant cases to a simple excision in hamartoma. In this paper, we report a novel case of sinonasal hamartoma, which demonstrates an unprecedented histological feature of glial tissue with astrocyte-like cells. Furthermore, we present the unconventional presenting symptoms and radiological features seen in this case that mimic the behaviours of nasal inverted papilloma (IP) lesions, thereby highlighting the need for careful investigation of such patients in order to distinguish both glial hamartoma and IP lesions. Concluding that identification of glial hamartoma as a new subtype of sinonasal hamartoma is crucial, as mistaking it for other lesions may subject patients to overly aggressive treatment and potential unnecessary harm.
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Affiliation(s)
- Nian Patel
- Otolaryngology, United Lincolnshire Hospitals National Health Service (NHS) Trust, Lincoln, GBR
| | - Mehmet Server
- Otolaryngology, United Lincolnshire Hospitals National Health Service (NHS) Trust, Lincoln, GBR
| | - Ahmed Bayoumi
- Otolaryngology, United Lincolnshire Hospitals National Health Service (NHS) Trust, Lincoln, GBR
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Yan F, Patel HP, Isaacson G. Age Distribution of Epistaxis in Outpatient Pediatric Patients. EAR, NOSE & THROAT JOURNAL 2023:1455613231207291. [PMID: 37864343 DOI: 10.1177/01455613231207291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Objectives: Little is known about the prevalence of epistaxis in children. Existing reports focus on hospitalized children or those presenting to an emergency department. To better understand pediatric epistaxis in clinical practice, we sought out a searchable, representative outpatient database and examined the incidence of epistaxis in children of different ages. Methods: A cross-sectional analysis of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from the years 2007 to 2011 was performed. The NHAMCS is a Centers for Disease Control and Prevention-curated national sample of data from visits to non-federally employed office-based physicians and health centers. We queried the NHAMCS to determine the cumulative incidence of epistaxis in children of different age groups. The International Classification of Diseases Ninth Revision code 784.7 was chosen to identify epistaxis. Comparisons of rates were performed using the chi-squared test. A P-value of <.05 was considered statistically significant. Results: In total, 55,435,691 children [27,816,237 (50.2%) males, 55,435,691 (77.2%) white] were included. The overall cumulative incidence rate of epistaxis was 2.4/1000 children. Children in the 3- to 5-year range had the highest cumulative incidence of epistaxis (5.0/1000), followed by those in the 6 to 8 (3.0/1000), 9 to 11 (2.0/1000), 0 to 2 (1.9/1000), 12 to 14 (1.6/1000), and 15 to 17 (0.5/1000) year ranges (P < .001). Conclusion: Pediatric epistaxis is common in the office setting (2.4 per 1000 children)-and well above emergency department estimates (1.7 per 1000 people). Children between the ages of 3 to 5 years have the highest cumulative incidence. Epistaxis is sufficiently unusual in infants and the late teens that alternative causes for nasal bleeding should be included in the differential diagnosis.
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Affiliation(s)
- Flora Yan
- Departments of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Hetvi P Patel
- Departments of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Glenn Isaacson
- Departments of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Liao J, Zhang X, Xu W, Li F, Qin G. Nasal Respiratory Epithelial Adenomatoid Hamartoma: Three Case Reports and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2023:1455613231198996. [PMID: 37743844 DOI: 10.1177/01455613231198996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Hamartomas, as non-true tumors, are commonly found in the lungs, digestive tract, and kidneys, and there are few clinical reports on nasal cases. Nasal histiocytosis accompanied by lymphatic lesions is a common feature of nasal hamartoma. Three patients with nasal cavity hamartoma were treated in our department, including 1 male and 2 females, with nasal obstruction or epistaxis. The imaging (computed tomography, magnetic resonance imaging) of 2 patients showed a soft tissue mass in the nasal cavity and no erosion of bone, while in 1 patient, the imaging was inconclusive. The excised material in all patients was found to be a soft mass. The 3 cases showed the same pattern under histological examination, and all 3 patients were diagnosed with nasal cavity respiratory epithelial adenomatoid hamartoma (REAH). Nasal hamartoma is a rare disease with nonspecific clinical manifestations and imaging features and is often misdiagnosed. Only by a better understanding of this disease can the rate of correct clinical diagnosis be improved.
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Affiliation(s)
- Jiangxue Liao
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xuge Zhang
- Department of Otolaryngology Head and Neck Surgery, Dazhou Integrated TCM & Wester Medicine Hospital, Dazhou, Sichuan, China
| | - Wei Xu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Fei Li
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Gang Qin
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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