Nasal chondromesenchymal hamartoma: Case report

A Systematic Review of Nasal Chondromesenchymal Hamartoma (NCMH) with a New Case Report

Nasal chondromesenchymal hamartoma (NCMH) is a very rare, benign sinonasal tract tumor commonly affecting infants. In this paper, in addition to presenting a systematic review of the literature on NCMH, we also report an unusual case of NCMH in an adolescent patient. A systematic review conducted following the PRISMA guidelines. PubMed, EMBASE and manual search through references of relevant publication were utilised to gather all published case-reports of NCMH. Data collected from each case-report for patient demographics, site and size of NCMH, clinical presentation, co-morbidities, diagnostic methods, treatment options and follow-up methods. The systemic review collected sixty-two case-reports of NCMH (including our case) affecting 42 men and 21 women (2:1 male to female ratio). Mean average age was 5.1 years (age range: 1 day to 70 years). The anatomical sites of the tumor were: nasal cavity (n = 17), paranasal sinuses (n = 30), orbital region (n = 17), and the base of the skull (n = 16). The reported clinical manifestations were nasal obstruction or congestion (n = 29), nasal mass (n = 27), epistaxis (n = 6), orbital symptoms (n = 14). NCMH is a very rare cause of nasal masses in infants and toddlers. Our case and previous case reports confirm that NCMH can mimic other benign and malignant tumors, therefore we should be vigilant for rare pathologies that lead to nasal masses. Recently the link between DIECR1 mutation with NCMH has been established, so NCMH should be considered in any patient with nasal or orbital symptoms with a history of DICER1-related tumor spectrum.

A Rare Cause of Respiratory Distress in Newborn: Huge Nasal Chondromesenchymal Hamartoma; Patient Report

ABSTRACT

Nasal chondromesenchymal hamartoma is a rare benign tumor of the sinonasal tract in pediatrics and only few cases in infantile, early pediatric, and adolescent population have been reported. Nasal chondromesenchymal hamartoma commonly presents as respiratory difficulty, intranasal mass, or facial swelling and typically arises from the nasal septum or vestibule, lest frequently maxillary or ethmoid sinuses, orbit, nasopharynx, and oropharynx. The authors report a case of nasal chondromesenchymal hamartoma that caused respiratory distress since birth, in a 4-week-old (28 days) infant which was arised from the medial aspect of the middle turbinate, an unexpected localization.

Pediatric Nasal Chondromesenchymal Tumors: Case Report and Review of the Literature

INTRODUCTION

Nasal chondromesenchymal tumors (NCMT) are rare benign neoplasms that usually present in children <1 year of age. They can display rapid growth and significant local bony remodeling that can mimic a malignant process. Of the ∼50 published cases to date, few have documented the need for neurosurgical intervention. We herein report a NCMT in an infant treated with a staged cranial and transnasal approach, as well as summarize the available literature on this pathology.

CASE REPORT

A newborn male with a compromised airway was noted to have a large sinonasal lesion. After stabilization, MRI demonstrated a 4-cm enhancing mass with diffuse sinus involvement and significant extension into the anterior cranial fossa, with displacement of the optic apparatus and hypothalamic pituitary axis. After an initial biopsy, the patient underwent a bifrontal craniofacial approach at 2 months of age, followed by a second-stage transnasal endoscopic approach at 15 months which resulted in a complete resection. There were no neurosurgical complications. Pathology was consistent with a NCMT.

DISCUSSION

Although rare, neurosurgical involvement is critical for the treatment of NCMTs with intracranial extension. Staged cranial and endonasal endoscopic approaches may be needed for complete resection of such lesions.

Endoscopic endonasal excision of nasal chondromesenchymal hamartoma with intracranial extension

INTRODUCTION

Nasal chondromesenchymal hamartoma (NCMH) is an extremely rare benign hamartoma of the sinonasal tract, predominantly involving infants and young children.

METHODS

We report the case of a 3-year-old boy of NCMH with extension to anterior skull base.

RESULTS

The tumor was completely resected piece by piece via an endonasal endoscopic approach. There is no recurrence 3 years after operation.

CONCLUSIONS

We reported the case of NCMH extending to skull base was successfully resected by endonasal endoscopic approach.

Nasal Chondromesenchymal Hamartoma (NCMH): a systematic review of the literature with a new case report

BACKGROUND

Nasal chondromesenchymal hamartoma (NCMH) is a very rare, benign tumour of the sinonasal tract usually presenting in infants. We present a systematic review of NCMH cases alongside a case report of an adult with asymptomatic NCMH.

METHODS

A systematic review was conducted in accordance with PRISMA guidelines. A PubMed, EMBASE and manual search through references of relevant publications was used to identify all published case-reports of NCMH. Data was collected from each case-report on: patient demographics, laterality, size and location of NCMH, presentation, co-morbidities, investigations, treatment and follow-up.

RESULTS

The systematic review identified 48 patients (including ours): 33 male, 15 female. Mean age was 9.6 years (range: 1 day-69 years) with the majority aged 1 year or younger at presentation (n = 18). Presentations included: nasal congestion (n = 17), nasal mass (n = 15) and eye signs (n = 12). NCMH also involved the paranasal sinuses (n = 26), orbit (n = 16) and skull-base (n = 14). All patients underwent operative resection of NCMH. A small 2014 case-series found DICER1 mutations in 6 NCMH patients, establishing a link to the DICER1 tumour spectrum.

CONCLUSIONS

NCMH is a rare cause of nasal masses in young children and adults. In light of the newly established link between NCMH and DICER1 mutations surgeons should be vigilant for associated DICER1 tumours, as NCMH may be the 'herald tumour' of this disease spectrum.