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Introduction Respiratory Epithelial Adenomatoid Hamartoma (REAH) is a benign disease that can resemble other malignant entities. Thus, it is essential to diagnose it accurately as the treatment approach differs, from radical surgeries in malignant cases, to a simple excision in hamartoma. We present an unusual case of bilateral REAH that was misdiagnosed, and hence it was treated aggressively. Case report A 57-year-old male patient presented with anosmia, 2-years history of bilateral nasal obstruction, and was accompanied with a moderate headache. An impression of olfactory neuroblastoma was made after history taking physical examination, and imaging studies. The patient underwent Functional Endoscopic Sinus Surgery (FESS), excisional biopsy of the cribriform plate mass bilaterally, and superior septectomy. Histopathologic examination of the bilateral masses showed sinonasal polyposis with crypting of surface mucosa and pseudoglandular formation. A diagnosis of sinonasal polyps with REAH was established. The patient's nasal obstruction improved, with no recurrence of sinusitis ± polyposis. However, he still complains of anosmia after 2-years follow-up. Conclusion Although REAH is a benign disease, it is critical to reach the correct diagnosis, in order to avoid aggressive treatment. Unfortunately, the preoperative investigations were not consistent with REAH, thus it was misdiagnosed and treated aggressively., Highlights • Respiratory Epitheliel Adenomatoid Hamartoma (REAH) is a benign disease that can resemble other malignant diseases. • The disease is commoner in males and in the third to ninth decades of life. • The significance of this article is to share our experience with this disease as we did not diagnose the case accurately. Thus the patient was treated aggressively for a malignant case, instead of a simple excision. Hence, one should keep REAH in mind when encountered a similar case to ours.

Malignant peripheral nerve sheath tumor (MPNST) is a rare disease in the parotid gland with a poor prognosis in most cases. The disease most often develops in the setting of neurofibromatosis type 1 (NF1) but can also occur sporadically. Herein, we report a rare case of MPNST in the parotid gland, in a patient with no previous history of NF1. Initial investigations of the patient, which consisted of laboratory investigations, ultrasound imaging of the swelling, fine-needle aspiration (FNA), computed tomography (CT) scan, and magnetic resonance imaging (MRI) of the neck and swelling, were compatible with a benign pleomorphic adenoma of the parotid gland. However, intraoperatively, the dissection was challenging as the tumor was adherent to the neighboring tissue. A diagnosis of MPNST arising from a diffuse neurofibroma was established based on clinicopathologic features of the disease. The patient, who exhibited clinical features compatible with (NF1), proceeded for radiotherapy following surgery to continue his treatment.

First branchial cleft anomalies are rare congenital malformations of the head and neck region. These anomalies account for less than 1% of all branchial anomalies. They are frequently misdiagnosed and hence mismanaged. The lesions are variable in presentation and course, making radiographic imaging techniques such as computed tomographic fistulography and magnetic resonance imaging the best first step in managing such cases. We present a 17-year-old Caucasian female who had a first branchial cleft fistula communicating between the right external auditory canal and the angle of the mandible. Surgical exploration revealed a completely subcutaneous tract not involving the parotid gland parenchyma, which makes this case even more significant.

Ectopic salivary tissue is commonly found in intraparotid and periparotid lymph nodes. Warthin tumor is the most common tumor arising in ectopic salivary gland tissue and in intraparotid lymph nodes. Although rare, neoplastic transformation of the ectopic salivary tissues is conceivable and other types of salivary gland neoplasms arising in intraparotid lymph nodes have been reported. Herein we report a rare case of a 32-year-old Kuwaiti male who presented with a mass in the right parotid gland. A preoperative fine needle aspiration suggested Warthin tumor. The patient underwent a superficial parotidectomy. The specimen showed a mass within the parotid parenchyma abutting the deep margin. Hematoxylin and Eosin stained sections of the lesion showed solid islands and cysts composed of epidermoid cells, mucus cells, and intermixed smaller “intermediate” cells within an intraparotid lymph node. The tumor was seen infiltrating the parotid parenchyma at the deep margin. Metastasis from distant sites was ruled out clinically, and the diagnosis rendered was MEC, low-grade, arising from ectopic salivary tissue in an intraparotid lymph node. Such cases are extremely rare and the presence of malignancies within lymph nodes may pose a diagnostic pitfall, which can affect patient management.

Castleman disease is an extremely rare benign lymphoproliferative disorder of unknown etiology. It affects the lymphatic chain in anybody region, although the commonest site is the mediastinum. The head and neck region is the second most common site; however, the salivary glands are rarely affected. We report a case of a 29-year-old Asian lady who presented with a 2-year history of an enlarging left parotid mass. Histopathology of the excisional biopsy confirmed the diagnosis of Castleman disease.

Kimura disease is a rare, benign, chronic inflammatory swelling of the subcutaneous tissue, lymph nodes, and glandular tissue. Characteristic features of the disease include, but not limited to, painless subcutaneous head and neck swelling, blood and tissue eosinophilia, and markedly elevated immunoglobulin E (IgE) levels. Herein, we report a rare case of Kimura disease manifesting as synchronous bilateral parotid swelling of 12 years duration in a 33-year-old Middle-Eastern man. To our knowledge only few cases have been reported in the literature involving bilateral parotid glands, and this is the first case to be reported in the Middle East.