Bilateral respiratory epithelial adenomatoid hamartoma with atypical behaviour.

A 69 year-old man, with bilateral inflamed sinonasal polyps that had been treated medically for years, referred for surgical treatment suffering from moderate progressive bilateral nasal obstruction, sinus pressure with no rhinorrhoea or other symptoms and typical bilateral inflamed polyps emerging from the middle meatus, not exceeding the level of the lower concha (Endoscopic Appearance Score of 8, Lildholdt scale grade 2 and Lund-Mackay grade 2 occupation shown on nasal endoscopy). CT requested and we maintained medical treatment with fluticasone furoate 27.5 g/day/nostril. Twenty days later, awaiting the results, the patient reported a sudden worsening of symptoms: serious nasal obstruction, rhinolalia clausa and mild spontaneous nosebleeds with massive growth of the ‘‘polyps’’, each seen from both nostrils as voluminous reddish masses, prone to bleeding, deforming the nose. The CT revealed polypoid lesions filling the nostrils with mild diffuse chronic frontal ethmoidal maxillary inflammation, with no bone erosion, infiltration or spread to adjacent structures. Nuclear magnetic resonance