Respiratory epithelial adenomatoid hamartoma, a different presentation

Respiratory epithelial adenomatoid hemartoma (REAH) has been included in the World Health Organization's classification of tumors since 2005. It results from non-neoplastic overgrowth of glandular tissue. It is rarely located in the upper airway and in 70% of these cases it is present in the nasal septum. Within the described locations, it has never been described as attached to the nasal floor. We present the case of a 56-year-old male patient with progressive right nasal obstruction for 2 years. A nasal endoscopy showed a large, well circumscribed, whitish lesion with lobulated contour and solid polypoidal components. The incisional biopsy was inconclusive and the computed tomography (CT) of the paranasal sinuses showed obliteration of the right nostril and of the upper nasopharyngeal and oropharyngeal airways by a lobulated lesion. We performed endoscopic excision of the 9 cm lesion attached to the nasal floor. Histopathologic study revealed REAH. Of uncertain etiology, REAH appears to correlate with chronic inflammation. It presents with nonspecific symptoms, which may mimic other nasal lesions. Despite not being described in the literature, our case presented REAH located in the nasal floor. Only excisional biopsy determines the diagnosis. Treatment involves complete endoscopic excision. REAH are underdiagnosed and its identification is important to avoid more aggressive treatments. In this article we present a rare case of a REAH located in the nasal floor, not described in the literature to this date.