**5.1 REAHs as a solitary lesion**

This clinical presentation of REAHs is actually the less frequent.

**Table 1** reports a cohort of eight cases diagnosed and treated in the ENT department of the CHU UCL Namur since 2008.

There were seven women. The mean age was 65 years old. Ranges are 27 and 81. There was one man: age 53 years old.

The lesions were unilateral in six patients (three left sided; three right sided) and bilateral in two.

Two patients were asymptomatic. REAH was diagnosed by nasal endoscopy and a sinus CT scanner performed for an assessment of epiphora, a case of nasal dysfunction and another one to rule out sinus disease associated to his allergic rhinitis.

The other patients complained with nasal obstruction and rhinorrhea.


**Table 1.** *Reports our experience of REAHs.* *REAHs and REAH-Like Lesions: Underdiagnosed lesions Often Misconfused with Nasal Polyps DOI: http://dx.doi.org/10.5772/intechopen.90327*

REAHS originated from the olfactory cleft in six patients and from the anterior wall of the sphenoid sinus in two cases.

On nasal endoscopy the lesion looked fleshy, with no vascular component and no necrosis.

On imaging the lesion was solitary in the olfactory cleft. No chronic rhinosinusitis was present (**Figure 16**).

The MRI performed in three cases was not so helpful. There were no pathognomonic features whatever was the localization. In the literature, REAHs appear as a homogeneous mass with post-contrast enhancement on T1-weighted sequences as well as hyperintensity on T2-weighted images (**Figure 17**) [13].

The diagnosis of REAH was confirmed in all the cases by the pathologist. In one case it was a COREAH, and in another case it was a seromucinous

hamartoma. These two hamartomas were located in the posterior nasal fossa. A biopsy was performed under local anesthesia in asymptomatic cases to make a formal diagnosis. For the other the diagnosis was made on the surgical specimen.

There was no clear etiologic factor that could have played a role in the development of REAH except in one patient suffering from allergic rhinitis. There was no concomitant chronic sinusitis, asthma, or aspirin intolerance.

Concerning the management, in two patients a wait and see attitude was proposed as the patient was not symptomatic. For the others an endoscopic resection of the lesion was performed under general anesthesia. The dissection was done in a subperiosteal plane. We have never drilled out the site of implantation. There was no need to do a full house ethmoidectomy.

**Figure 16.** *Comparison between CT scan and nasal endoscopy.*

On the other hand, low-grade non-intestinal adenocarcinomas (LGSNAC) are less common and less invasive. There is no sex or racial predilection. There is no association with wood dust exposure. They have no tendency to give systemic metastasis. However, they have a potential for local invasion and destruction of tissue. Extensive surgery is recommended to be associated with radiotherapy in

Immunohistochemistry shows the positivity for CK7 and S100 and negativity for

Histologically, the mass originates from the surface epithelium and the seromucinous glands of the submucosa. It consists of glandular proliferations lined by cuboidal to columnar cells which are usually monomorphic and cytologically bland. It forms a diverse group of bland tubular and/or papillary tumors. Mitoses are rare. Necrosis, perineural invasion, and lymphovascular invasion are absent.

The main differential diagnosis is between LGSNAC and seromucinous

This clinical presentation of REAHs is actually the less frequent.

**Patient Gender Side Symptoms**

implantation

R/sphenochoanal recess

recess

H. C. Female L/olfactory cleft Unilateral nasal obstruction 2019 Tr. M. Female R/olfactory cleft Asymptomatic Ct finding 2019 N, A. Male X2 R > L Allergic rhinitis; paucisymptomatic/nasal

Br, L. Female R/olfactory cleft Asymptomatic dacryoscan; 2009

Van rent. M. Female X2/olfactory cleft Bilateral nasal obstruction 2012

**Table 1** reports a cohort of eight cases diagnosed and treated in the ENT

There were seven women. The mean age was 65 years old. Ranges are 27 and 81.

The lesions were unilateral in six patients (three left sided; three right sided) and

Two patients were asymptomatic. REAH was diagnosed by nasal endoscopy and a sinus CT scanner performed for an assessment of epiphora, a case of nasal dysfunction and another one to rule out sinus disease associated to his allergic rhinitis. The other patients complained with nasal obstruction and rhinorrhea.

Unilateral nasal obstruction 2008

Unilateral nasal obstruction 2012

Unilateral nasal obstruction/nasal collapse 2019

endoscopy/CT scan 2019

The stroma contains an inflammatory infiltrate as in REAHs.

some cases.

CK20 and CDX2.

hamartoma (**Figure 15**).

**5.1 REAHs as a solitary lesion**

*Sino-Nasal and Olfactory System Disorders*

department of the CHU UCL Namur since 2008.

There was one man: age 53 years old.

Sch, M. Female L/septal

Seromucinous hamartoma

B. Pat. Female/COREAH L/sphenochoanal

W. Jes. Female

*Reports our experience of REAHs.*

**Table 1.**

**62**

**5. Our experience**

bilateral in two.

**Figure 17.** *MRI of a patient with bilateral REAHs: T1- and T2-weighted sequences.*

Until now we have had no recurrence (**Figure 18**).
