A case of respiratory epithelial adenomatoid hamartoma in a patient suffering from non-steroidal anti-inflammatory drug - exacerbated respiratory disease

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare lesion located mostly in the anterior and upper parts of the nasal cavity, caused by pseudo-glandular proliferation of the respiratory epithelium, enriched with goblet cells. The stroma is characterized by a dense infiltrate composed mainly of mast cells. Previous studies have indicated a strong association between REAH located in the olfactory area and allergic rhinitis. We present the case of a 48-year-old man with a history of NSAID-exacerbated respiratory disease (N-ERD) who underwent surgical removal of a lobed, cerebriform, yellowish-pink mass from the right olfactory region. Also, bilateral inflammatory nasal polyps were removed. We discuss the still-unclear etiopathogenesis of REAH, the challenges of diagnosing this rare lesion, and the role of N-ERD in the development and growth of this condition. We propose that REAH can be understood as a rare tumor lesion, formed based on local developmental anomalies, the growth of which requires stimulation by inflammatory mediators. Although there is a high degree of association between REAH and allergic rhinitis, this case indicates that this lesion can also occur in patients with N-ERD.