31st Congress of the European Society of Pathology; Nice, France; 7th-11th September 2019.
Sunday, 8th September 2019 17.15-19.15.
Uranie-Calliope.
SS-03 slide seminar:
Case 5.
Roderick H.W. Simpson.
University of Calgary, Alberta, Canada.
Department of Laboratory Medicine & Pathology
Declaration of Conflict of Interest
• I have had no affiliation (financial or otherwise) with a pharmaceutical, medical device, and/or communications organization during the past two years.
31st Congress of the European Society of Pathology; Nice, France; 7th-11th September 2019.
Sunday, 8th September 2019 17.15-19.15.
Uranie-Calliope.
SS-03 slide seminar:
Case 5.
Roderick H.W. Simpson.
University of Calgary, Alberta, Canada.
Co-author: Dr. Martin Hyrcza, Univ of Calgary.
31st Congress of the European Society of Pathology; Nice, France; Sunday, 8th September 2019, 17.15-19.15.
Case no. 5. _________________________________________________________________________________________________________________________________________________________________________________________________________
Clinical History.
Male 73.
Long-standing history of congestion and rhinorroea, worse in cold weather.
No epistaxis.
Imaging: large right-sided nasal mass seems to arise from posterior septum.
Extends into nasopharynx.
Case 5: CT mass in right nasal cavity.
Case 5: Gross description.
Irregular rubbery mass weighing 10 grams and measuring 44 × 26 × 21 mm. The cut surface is solid and tan-coloured.
Case 5: Overview-1.
Case 5: Overview-2.
5 aspects:1. Cystic structures.
2. Basaloid areas.
3. Glandular areas.
4. Oncocytic and respiratory epithelial areas.
5. Stroma.
Case 5: Cystic structures-1.
Case 5: Cystic structures-2.
Case 5: Basaloid areas-1.
Case 5: Basaloid areas-2.
Case 5: Sero-mucinous glands-1.
Case 5: Sero-mucinous glands-2.
Case 5: Oncocytic area.
Case 5: Respiratory epithelial structure with cilia.
Case 5: Stroma, cellular with oedematous areas.
Case 5.
?What is your diagnosis?
Case 5.
?What is your diagnosis?
My impression at this stage was that the imaging suggested a hamartoma, but the histology did not
fit with either sero-mucinous or REAH (Respiratory Epithelial Adenomatoid
Hamartoma).
Will immunohistochemistry and special stains help?
Case 5: Secretions and rare goblet cells.PASD Mucicarmine
PASD Mucicarmine
Case 5: Immunohistochemistry-1.
CK7
DOG1 – mainly
seromucinous
glands.
CK19
GCDFP15 – mainly
seromucinous glands.
Case 5: Immunohistochemistry-2.p63 p40
CK5/6 S-100
Case 5: Immunohistochemistry-3, stroma.
SMMS Androgen Receptors
CD34CD10
Case 5: Immunohistochemistry Ki-67 – focally high.
Case 5: Immunohistochemistry.
The following investigations were negative:
IHC
CK20, CDX2, GATA3, Mammaglobin.
ER, PR, p16.
TTF-1, Synaptophysin.
FISH
MAML2
Case 5. Diagnosis.
Did immunohistochemistry and special stains help? Somewhat, but no definite answer.
My impression at this stage was that the overall appearance suggested a sinonasal hamartoma-like lesion, but histology and IHC still did not fit with
either sero-mucinous hamartoma or REAH.
It is probably a related benign lesion, but the focally high proliferation is a little worrying.
Case 5. Outcome.
No information on the website, but…
Had routine blood tests in June 2019, so presumably…
Well.
Respiratory Epithelial Adenomatoid Hamartoma (REAH).________________________________________________________________________________________________________________________________________________________________________________
Definition: “…a benign acquired overgrowth of indigenous glands of the sinonasal tract arising from the surface epithelium.” WHO 2017.
Sex: distinct male predominance.
Age: 3rd-9th decade.
Site: Most in posterior nasal septum.
REAH: proliferation of glands and ducts.
WHO 2005
Seromucinous Hamartoma.________________________________________________________________________________________________________________________________________________________________________________
Definition: “…a benign acquired overgrowth of indigenous seromucinous glands of the nasal cavity and paranasal sinuses.” WHO 2017.
Sex: male:female = 3:2.
Age: 14-85 (mean 56).
Site: Most in posterior nasal septum or nasopharynx.
Seromucinous Hamartoma.________________________________________________________________________________________________________________________________________________________________________________
WHO 2005.
WHO 2017.
IHC: CK19+, S-100+. Absence of basal-myoepithelial cells.
Scattered positivity for p63 – Huang Y-W et al 2018
Case 5: What next?
Toronto (Ilan Weinreb, Bayardo Perez-Ordoñez).
“The polyp is favoured to represent a seromucinoushamartoma. However, some of the features are unique and may represent an as yet unrecognized variant of the hamartoma spectrum.”
Also, Alena Skálová, Plzeň, Czech Republic.
Case 5: Summary.
• Clinically fits with a sinonasal hamartoma.
• Microscopically a benign or at worst low grade malignant proliferation
• BUT….microscopically does not really resemble REAH or Seromucinous Hamartoma.
Questions:
• Is it a true hamartoma or a benign neoplasm?
• What name should it be given?
Perhaps – Multiphenotypic sinonasal adenoma or hamartoma.
Lake Peyto, Banff National Park, Canada; May 2016.
Any Questions?
OR suggestions.
