Occupational rhinitis caused by hypersensitivity to black pepper.

Black pepper (Piper nigrum) rarely leads to allergic inflammation of the nasal mucosa. This is a presentation of a 52-year-old female worker exposed to black pepper dust for 10 years suffering from allergic rhinitis and chronic rhinosinusitis. She complained of nasal obstruction, rhinorrhoea, and a weakened sense of smell. Clinical examination showed the bilateral presence of polypoid lesions arising from the middle turbinate. After surgery, histopathological examination confirmed the diagnosis of inflammatory nasal polyps. Duration of exposure to black pepper and serum concentration of specific immunoglobulin E antibodies indicating work-related exposure would support a causal link between exposure to these factors and the development of chronic inflammation in the nasal mucosa. Inflammatory nasal polyps may be noted in the nasal cavity in workers exposed to black pepper dust. The absence of exposure to black pepper resulted in no detectable circulating antibodies one year after the change of workplace.

TREATMENT OF CONGENITAL LARYNGEAL CYSTS IN NEWBORNS.

Congenital laryngeal cysts are rare lesions that may occur in newborns, characterized by symptoms of respiratory obstruction and severe dyspnea. The aim of this study was to indicate optimal surgical treatment of congenital laryngeal cysts in newborns. We present a case series of five neonates treated for congenital laryngeal cysts during the 2011-2017 period at our pediatric tertiary care hospital. Patient age ranged from one day to 14 days. All patients had unilateral cysts. After surgical excision, burning of the walls of the cysts was performed by a CO2 laser. In one case, after four months, a recurrent cyst appeared, and re-operation was performed. Our relatively small case series indicates that symptoms such as stridor and labored breathing can occur already during the first days of life and potentially endanger the patient's life. Complete excision of the cyst and burning of its walls with CO2 laser leads to complete cure and prevent recurrence of the lesion.

Is otitis media with effusion associated with Samter's triad a new nosological entity? A preliminary report on inflammatory mediator production.

PURPOSE: Otitis media with effusion (OME) associated with Samter's triad (ST) is a difficult entity to treat. The aim of study was an investigation of the middle ear and nasal production of inflammatory mediators (IM) in patients with ST and analysing differences between them and controls. METHODS: Prospective case-control study. Nineteen patients with OME (five had allergic rhinitis, four had nasopharyngeal lymphoid hyperplasia, five had no evident sino-nasopharyngeal disease and five had confirmed ST) and 15 healthy participants were included. The concentrations of IM interleukin-1 beta (IL-1ß), interferon-alpha 2 (IFN-α2), interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23 and IL-33 were measured in nasal and middle ear secretions. RESULTS: There was a difference that was close to a level of statistical significance only for IL-1ß levels in middle ear fluid (p = 0.052) between the ST subgroup and the other patients with OME. Also, we found a significant difference for IL-23 in nasal secretions between these subgroups (p = 0.040), whereas the difference in nasal fluid IL-33 was close to a level of statistical significance (p = 0.052). There was a significant difference in nasal concentrations of IL-1ß, IFN-α2, MCP-1, IL-8, IL-18 and IL-33 (p < 0.001, p = 0.005, p = 0.008, p = 0.011, p = 0.011 and p = 0.011, respectively) between the OME group and the healthy subjects. There were significant positive correlations between concentrations of IL-1ß, IFN-α2, IFN-γ, TNF-α, MCP-1, IL-17A, IL-18 and IL-33 (p < 0.001, p < 0.001, p = 0.002, p = 0.028, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively) in nasal and middle ear secretions. CONCLUSION: This preliminary report showed some differences in IM production between the patients with OME associated with ST and those without it. Our results suggest a uniformity of the production of nasal and middle ear IM and supported the concept of a united airway respiratory disease.

Choanal polyps in children and adults: 10-year experience from a tertiary care hospital.

PURPOSE: Choanal polyps (CPs) are benign, solitary, soft-tissue lesions extending towards the junction between the nasal cavity and the nasopharynx through the choana. The aim of this retrospective study was to evaluate clinical and histological characteristics of CPs in children comparing to adult patients. METHODS: Characteristics of CPs treated in our hospital (demography, main complaints, side, localization, surgical approach, histological characteristics, accompanying paranasal sinus diseases, association with allergic rhinitis, postoperative follow-up period, and recurrence rates) were retrospectively reviewed. RESULTS: Seventy-eight patients with CPs were included, 22 (28%) patients in children and 56 (72%) patients in adults. We found no differences in the prevalence of main nasal complaints (nasal obstruction, rhinorrhea, snoring, and epistaxis) between the child and adult. In 27% children and in 7% adults, we found the oropharyngeal extension of CPs (p < 0.01). In 18% children and in 5.3% adults, we found the histological characteristics of an angiomatous CP (p < 0.05). The association with allergic rhinitis was more frequent in children (32%) than in adults (18%) (p < 0.05). In 32% pediatric patients and in 14% adult patients, we found the association with ipsilateral chronic maxillary rhinosinusitis without nasal polyps (CRSsNP) (p < 0.05). After the surgical treatment, we found the recurrence in 3 (14%) pediatric and in 5 (8%) adult patients, without the significant difference. CONCLUSION: Our results suggest some specificities of CPs in children comparing to adults. Oropharyngeal extension, association with allergic rhinitis and ipsilateral CRS, and the presence of angiomatous histological type of CPs are more frequent in the pediatric population.

ARF6-mediated endosomal transport of Telencephalin affects dendritic filopodia-to-spine maturation.

Dendritic filopodia are dynamic structures thought to be the precursors of spines during synapse development. Morphological maturation to spines is associated with the stabilization and strengthening of synapses, and can be altered in various neurological disorders. Telencephalin (TLN/intercellular adhesion molecule-5 (ICAM5)) localizes to dendritic filopodia, where it facilitates their formation/maintenance, thereby slowing spine morphogenesis. As spines are largely devoid of TLN, its exclusion from the filopodia surface appears to be required in this maturation process. Using HeLa cells and primary hippocampal neurons, we demonstrate that surface removal of TLN involves internalization events mediated by the small GTPase ADP-ribosylation factor 6 (ARF6), and its activator EFA6A. This endocytosis of TLN affects filopodia-to-spine transition, and requires Rac1-mediated dephosphorylation/release of actin-binding ERM proteins from TLN. At the somato-dendritic surface, TLN and EFA6A are confined to distinct, flotillin-positive membrane subdomains. The co-distribution of TLN with this lipid raft marker also persists during its endosomal targeting to CD63-positive late endosomes. This suggests a specific microenvironment facilitating ARF6-mediated mobilization of TLN that contributes to promotion of dendritic spine development.

Association of locally produced IL10 and TGFb1 with tumor size, histological type and presence of metastases in patients with lung carcinoma.

PURPOSE: Advanced lung carcinoma is charasterized with fast disease progression. Interleukin (IL)10 and transforming growth factor (TGF)b1 are immunosuppressive mediators and their role in lung carcinoma pathogenesis and in the antitumor response has not yet been elucidated. The purpose of this study was to correlate IL10 and TGFb1 levels in the serum and lung tumor microcirculation with clinical stage, disease extent, histological features and TNM stage. METHODS: The study included 41 lung cancer patients in clinical stage III and IV. Histological type was determined immunohistochemically, while tumor size, localization and dissemination were determined radiologically by multislice computerized tomography (MSCT). IL10 and TGFb1 levels were quantified with commercial flow cytometric test in serum and lung tumor microcirculation samples. RESULTS: Non small cell lung cancer (NSCLC) patients had significantly elevated TGFb1 while small cell lung cancer (SCLC) patients had significantly increased IL10 in tumor microcirculation. IL10 was significantly elevated in patients with the largest tumors, as well as in patients with III clinical stage and without metastases, both in the serum and tumor microcirculation. TGFb1 was significantly increased in serum and tumor microcirculation in patients with larger tumors. We found significant correlation between these two immunosuppressive cytokines, IL10 and TGFb1, in tumor microcirculation but not in patient serum samples. CONCLUSION: IL10 and TGFb1 in systemic and tumor microcirculation are significantly associated with particular histological type of lung cancer, tumor size and degree of disease extent.

Early etiology of Alzheimer's disease: tipping the balance toward autophagy or endosomal dysfunction?

Alzheimer's disease (AD) is the most common form of dementia in the elderly. This brain neuropathology is characterized by a progressive synaptic dysfunction and neuronal loss, which lead to decline in memory and other cognitive functions. Histopathologically, AD manifests via synaptic abnormalities, neuronal degeneration as well as the deposition of extracellular amyloid plaques and intraneuronal neurofibrillary tangles. While the exact pathogenic contribution of these two AD hallmarks and their abundant constituents [aggregation-prone amyloid ß (Aß) peptide species and hyperphosphorylated tau protein, respectively] remain debated, a growing body of evidence suggests that their development may be paralleled or even preceded by the alterations/dysfunctions in the endolysosomal and the autophagic system. In AD-affected neurons, abnormalities in these cellular pathways are readily observed already at early stages of disease development, and even though many studies agree that defective lysosomal degradation may relate to or even underlie some of these deficits, specific upstream molecular defects are still deliberated. In this review we summarize various pathogenic events that may lead to these cellular abnormalities, in light of our current understanding of molecular mechanisms that govern AD progression. In addition, we also highlight the increasing evidence supporting mutual functional dependence of the endolysosomal trafficking and autophagy, in particular focusing on those molecules and processes which may be of significance to AD.

Macrophage inflammatory protein-1 production and eosinophil infiltration in chronic rhinosinusitis with nasal polyps.

OBJECTIVE: Eosinophil recruitment to the nasal mucosa involves a number of chemokines. The aim of this study was to evaluate nasal secretion levels of macrophage inflammatory protein-1 alpha (MIP-1α) and MIP-1ß and to correlate these levels with clinical characteristics and degree of eosinophilia in nonallergic and allergic patients with nasal polyposis (NP). METHODS: Fourteen nonatopic and 14 atopic patients with NP were recruited for this cross-sectional study. Fourteen healthy subjects were included as controls. The concentrations of MIP-1α and MIP-1ß in nasal secretions were measured by flow cytometry. Eosinophil counts were performed by cytological examination of the scraped nasal mucosa. We scored each of the 28 patients according to the nasal symptom score, endoscopic score, and computed tomography (CT) score. RESULTS: We found significantly higher concentrations of MIP-1α in nasal fluid of nonallergic and allergic NP patients compared to control subjects. In nonallergic patients, we found positive correlations between MIP-1α levels and endoscopic score, CT score, and the percentage of eosinophils. CONCLUSION: MIP-1α may play a role in eosinophil recruitment in NP. Our results suggest that the measurement of MIP-1α in nasal secretions could be useful in evaluating the degree of eosinophil inflammation and severity of disease in nonallergic patients.

ADP ribosylation factor 6 (ARF6) controls amyloid precursor protein (APP) processing by mediating the endosomal sorting of BACE1.

Amyloid ß (Aß) peptides, the primary constituents of senile plaques and a hallmark in Alzheimer's disease pathology, are generated through the sequential cleavage of amyloid precursor protein (APP) by ß-site APP cleaving enzyme 1 (BACE1) and γ-secretase. The early endosome is thought to represent a major compartment for APP processing; however, the mechanisms of how BACE1 encounters APP are largely unknown. In contrast to APP internalization, which is clathrin-dependent, we demonstrate that BACE1 is sorted to early endosomes via a route controlled by the small GTPase ADP ribosylation factor 6 (ARF6). Altering ARF6 levels or its activity affects endosomal sorting of BACE1, and consequently results in altered APP processing and Aß production. Furthermore, sorting of newly internalized BACE1 from ARF6-positive towards RAB GTPase 5 (RAB5)-positive early endosomes depends on its carboxyterminal short acidic cluster-dileucine motif. This ARF6-mediated sorting of BACE1 is confined to the somatodendritic compartment of polarized neurons in agreement with Aß peptides being primarily secreted from here. These results demonstrate a spatial separation between APP and BACE1 during surface-to-endosome transport, suggesting subcellular trafficking as a regulatory mechanism for this proteolytic processing step. It thereby provides a novel avenue to interfere with Aß production through a selective modulation of the distinct endosomal transport routes used by BACE1 or APP.

Clinical case report of a large antrochoanal polyp.

Antrochoanal polyps are benign lesions originating from the mucosa of the maxillary sinus. Nasal obstruction and rhinorrhea are their main symptoms. Their endoscopical and radiological appearance makes them relatively easy to diagnose. These polyps are usually presented unilaterally, although bilateral presentation is also possible. We described two cases of atypically giant antrochoanal polyps: in a 15-year-old child and in a 38-year-old man. In both cases, the diagnosis was done by nasal endoscopy and computed tomography (CT) of the paranasal sinuses and supported by histopathological analysis. In the first patient, the excised polyp had the histological characteristic of an angiomatous antrochoanal polyp. Because of their unusual dimension, the combined transoral and endonasal endoscopic approach was performed for complete polyp excision. We discussed the clinical, histopathological and immunohistochemical characteristics of choanal polyps in comparison to inflammatory nasal polyps, and the applicable surgical techniques for treatment of these polyps.

The effect of nasal douching by hypertonic 2.3 per cent sea water with algae extracts on the concentration of epidermal growth factor, transforming growth factor-α and interleukin-8 in nasal secretions of patients with nasal polyposis following endoscopic surgical treatment.

OBJECTIVE: To investigate epidermal growth factor, transforming growth factor-α and interleukin-8 production in nasal mucosa irrigated with hypertonic 2.3 per cent solution with algae extracts, in comparison to 0.9 per cent NaCl during the first two weeks after surgery for nasal polyposis, in relation to symptoms and local findings. METHODS: This prospective study included 20 nasal polyposis patients postoperatively irrigated with hypertonic solution and 20 nasal polyposis patients postoperatively irrigated with isotonic solution. We evaluated nasal symptom score, endoscopic score and mediator levels in nasal secretions before and after irrigation. RESULTS: Following treatment, nasal symptom score and endoscopic score were significantly lower in the hypertonic solution group (p = 0.023; p < 0.001, respectively). The increase in the epidermal growth factor and the decrease in the transforming growth factor-α and interleukin-8 concentration were higher in the hypertonic group (p < 0.001 for all mediators). CONCLUSION: Irrigation with a hypertonic solution was found to be more effective than an isotonic solution in nasal mucosa reparation.

Immunohistochemistry in diagnosis of extranasopharyngeal angiofibroma originating from nasal cavity: case presentation and review of the literature.

Angiofibromas are rare vascular tumors which originate predominantly in the nasopharynx and occur typically in male adolescents. Extranasopharyngeal sites such as nasal cavity and paranasal sinuses are less frequent. This review article was undertaken to evaluate the incidence, clinical features and management of extranasopharyngeal angiofibromas originating exclusivelly from nasal cavity structures. Our focus of interest was to evaluate the significance of immunohistochemical analysis in diagnosis of such extremely rare neoplasms. In the PubMed and Google Search, we found only 39 cases of nasal angifibroma, 27 males and 12 females from 1980 to 2012. The most prevalent site of origin was nasal septum, followed by inferior and middle turbinate. The commonest symptoms were nasal obstruction and epistaxis. Nasal angiofibromas are clinically distinct from nasopharyneal angiofibromas and can therefore be misdiagnosed. The differential diagnosis includes other vascular lesions, such as lobular capillary hemangioma and sinonasal-type hemangiopericytoma. Although immunohistochemistry is not necessary for differentiation between angiofibroma and capillary hemangioma, that diagnostic procedure may be helpful in distinction from sinonasal hemangiopericytoma. As an ilustration for immunohistochemical analysis, we presented a case of an elderly woman with tumor arising from the middle turbinate, diagnosed as angiofibroma. The staining was positive for CD34, CD31, factor VIII, vimentin and smooth muscle alpha-actin, and negative for desmin.

Inflammatory mediators in nasal secretions of patients with nasal polyposis with and without aspirin sensitivity.

BACKGROUND: The aim of this cross-sectional study was to compare the levels of inflammatory mediators in nasal secretions in patients with aspirin-exacerbated respiratory disease (AERD) and in those with nasal polyposis (NP) without aspirin-sensitivity and to correlate nasal fluid mediator concentrations with clinical parameters of the disease. METHODS: A total of 30 patients with AERD, 30 chronic rhinosinusitis (CRS) with NP patients without aspirin sensitivity (CRSwNP), and 30 control subjects without inflammation of the nasal mucosa (C), selected for surgical treatment entered the study. The total nasal symptom score (TNSS), endoscopic score (ES), and Lund-Mackay score (LMS), were evaluated. The concentrations of eosinophil cationic protein (ECP), tryptase, heat shock protein 70 (HSP70), substance P and Clara cell protein 16 (CC16) were determined in nasal secretions. RESULTS: Higher concentrations of ECP, tryptase, and HSP70 were measured in the AERD patients than in the CRSwNP patients and the C group (p < .001; p < .001, respectively for all mediators). However, levels of CC16 were higher in the C group than in the AERD and CRSwNP groups (p < .001; p < .001, respectively). A positive correlation between the TNSS and CC16 and a negative one between CC16 and tryptase levels were found in the C group. The CRSwNP group showed positive correlations between ECP, HSP70, and tryptase and negative correlations between substance P, ES, and LMS, as well as between CC16 and tryptase levels. In the AERD group, we found a positive correlation between HSP70 and ECP levels and a negative correlation between the TNSS and CC16 concentration. CONCLUSION: The obtained results indicate the increased production of mediators of eosinophil and mast cell function, and the decreased production of biomarker of respiratory epithelial function in AERD patients. Clinical and biochemical parameters correlate in different ways in the AERD and CRSwNP patients.

Chondromesenchymal Hamartoma With Nasopharyngeal Involvement: Two Unusual Cases of an Extremely Rare Lesion.

Chondromesenchymal hamartoma (CMH) is a rare, benign lesion of the nasal cavity, paranasal sinuses, and skull base, composed of islands of hyaline cartilage in a myxoid background. The vast majority of CMH cases are infants and young children. According to the world literature, nasopharyngeal involvement of CMH is extremely rare. In all cases, the lesions were masses protruding from the nasal cavity or paranasal sinuses to the nasopharynx. We hereby report 2 adult male patients with masses completely situated in the nasopharyngeal space. In the first patient, the tumor originated from the posterior edge of the nasal septum and in the second one, from the posterolateral wall of the nasopharynx, adjacent to the pharyngeal orifice of the Eustachian tube. In both patients, the lesion was excised endoscopically, and histopathological analyses were consistent with a diagnosis of CMH. To our knowledge, those are the only cases of CMH completely situated in the nasopharynx.

Maxillary Sinus Lobular Capillary Hemangioma in a 15-Year-Old Boy.

Lobular capillary hemangioma (LCH) is a benign capillary proliferation with a microscopically distinctive lobular architecture, composed of small to medium-sized vessels of capillary type. Rarely, it originates from the mucosa of the nasal cavity, most frequently from the anterior nasal septum, turbinates, and nasal vestibule. Etiology is unclear, but previous investigations suggest that this lesion is associated with injury, hormonal factors, some viral infections, and therapy with some drugs. We present a case of LCH arising from the medial wall of the maxillary sinus in a 15-year-old boy, which was completely excised by preoperative embolization and endoscopic sinus surgery. To our knowledge, this is the second reported case of an LCH originating from the maxillary antrum. Etiology, pathogenesis, diagnosis, and treatment modalities of LCH were also discussed.

Giant Fibrovascular Polyp as an Unusual Cause of Globus Pharyngeus.

Differential diagnosis of globus sensation in an otherwise asymptomatic patient should include hypopharyngeal fibrovascular polyp to avoid potentially fatal complications like airway compromise following regurgitation. We present a case of a 74-year-old man with a 13-cm long hypopharyngeal fibrovascular polyp with 9 months history of globus sensation. A narrow stalk of the giant polyp allowed endoscopic removal and complete resection with the CO2 laser. Histopathological examination was conclusive for the fibrovascular polyp.

Angiogenesis and eosinophilia in the nasal mucosa of patients with different clinical phenotypes of chronic rhinosinusitis.

INTRODUCTION: Dense inflammatory cell infiltration and vascularization of the nasal mucosa are histological characteristics of chronic rhinosinusitis (CRS). We aimed to evaluate the association between eosinophilia and vascularization in the stroma of mucosal layer/nasal polyps (NP) and clinical parameters in patients with different phenotypes of CRS. METHODOLOGY: This cross-sectional study involved 33 patients who had CRS with NP without aspirin sensitivity (CRSwNP), 20 NP patients as a part of aspirin-exacerbated respiratory disease (AERD), and 10 patients who had CRS without NP (CRSsNP), selected for surgery. Control group consisted of 31 subjects without nasal/sinus inflammation, selected for surgery of pneumatized middle turbinate. All patients were clinically scored before surgery for nasal symptoms, quality of life (QoL) outcome and findings from computed tomography scans. NP/nasal mucosa samples of participants were immunohistochemically stained for eosinophil infiltration marker BMK13 and angiogenesis markers CD31 and CD34. RESULTS: AERD patients had the highest level of immunoexpression for BMK13. The strongest staining pattern of CD34 was found in AERD group and the highest expression level for CD31 in CRSwNP group. We found a positive correlation between BMK13, impaired QoL and radiologically evaluated disease extent in patients with CRSwNP. Excepting CRSsNP patients, no correlation was found between the marker of tissue eosinophilia and markers of vascular proliferation. CONCLUSIONS: Patients from AERD phenotype have the highest degree of stromal eosinophilic infiltration and endothelial proliferation in comparison to other CRS phenotypes. Eosininophil infiltration marker BMK13 correlates better with the clinical parameters of CRS in comparison to the vascular proliferation markers.

Assessment of chronic rhinosinusitis severity indicators: radiological and clinical perspective.

INTRODUCTION: Chronic rhinosinusitis (CRS) is inflammation of the nasal cavity and paranasal sinus mucosa. The aim of this study was to examine which of the available radiological and clinical parameters is the best indicator of the CRS severity. METHODOLOGY: In order to classify CRS, we used both a subjective assessment tool such as SNOT-22 questionnaire, as well as an objective tool such as clinical examination. We introduced three forms of CRS (mild, moderate and severe). Within these groups, we evaluated the computerized tomography (CT) parameters used as an indicator of bone remodeling, the Lund-Mackay score (LMS), CT properties of the soft tissue content in the maxillary sinuses, presence of nasal polypus (NP), presence of fungal infection and parameters indicating allergic status. RESULTS: Frequencies of NP, positive eosinophil count, presence of fungi, areas of high attenuation, and duration of CRS and LMS significantly increased with the increased severity of CRS. Anterior wall thickness and density increased in the severe forms of CRS in the group assessed by SNOT-22. Positive correlation was detected between LMS and maximal density of sinus content and between duration of CRS and anterior wall thickness. CONCLUSIONS: Morphological changes of sinus wall detected in CT could be a useful indicator of CRS severity. Changes in bone morphology are more likely to occur in patients with longer-lasting CRS. The presence of fungi, allergic inflammation of any origin and nasal polypus potentiates more severe forms of CRS both clinically and subjectively.

Effectiveness of the Treatment of Rhinogenic Headache Caused by Intranasal Contact.

OBJECTIVES: The aim of the study is to evaluate the effectiveness of the surgical and nonsurgical treatment of headache caused by contact points (CPs) between the nasal septum and inferior or middle turbinate. METHODS: The research was designed as a prospective clinical case-series study. The patients with CP headaches were offered to choose between 2 treatment options, surgery and medical treatment. Two groups of surgically treated patients (surgery groups 1 and 2, depending on whether there is a contact between nasal septum and inferior turbinate or middle turbinate) were evaluated and compared for headache intensity and frequency. Headache intensity was measured using a visual analog scale value from 0 to 10; the frequency of headache was expressed as the number of days during 1 month with a headache (before surgery, 1 month, and 6 months after surgery). A comparison was also made between surgically and nonsurgically treated patients. RESULTS: We found more intensive and frequent headache in patients who had CP between the nasal septum and the middle turbinate (P = .038 and P = .003, respectively). A significant reduction in headache intensity and frequency was found in both groups of surgically treated patients 6 months after surgery; however, this reduction was more significant in patients with mucosal contact between nasal septum and middle turbinate. The nonsurgical treatment made a significant reduction of headache intensity and frequency at 1-month follow-up (P = .012 and P = .031, respectively), but not at 6-month follow-up (P = .114 and P = .088, respectively). CONCLUSION: Surgery gave a statistically significant reduction in the intensity and frequency of headache, which was assessed 6 months after surgery. Surgery was found as superior to nonsurgical treatment in the therapy of CP headache.

Simultaneous Nasal Septal Schneiderian Papilloma and Respiratory Epithelial Adenomatoid Hamartoma.

Schneiderian papilloma is typically found on the lateral nasal wall, but, in rare cases, can be located at the mucosa of the nasal septum. Respiratory epithelial adenomatoid hamartoma (REAH) is rare, non-neoplastic lesion characterized by an abnormal proliferation of glandular part of the respiratory nasal mucosa. We present a case of a 42-year-old man with five-year history of bilateral nasal obstruction, rhinorrhea, epistaxis, and hyposmia. On endoscopic examination, we found lobulated, yellowish-pink soft tissue masses on both sides of the nasal septum. The results of histopathological analyses showed the characteristics of Schneiderian papilloma in the lesion excised from the right and REAH in the lesion excised from the left side of the nasal cavity. To our knowledge, cases of simultaneous presentation of Schneiderian papilloma and REAH on opposite sides of the nasal septum have not been published so far. An appropriate cooperation of rhinologist and pathologist allows for a correct diagnosis of these rare and unusual lesions.