Weinreb Ilan, Gnepp Douglas R, Laver Nora M, Hoschar Aaron P, Hunt Jennifer L, Seethala Raja R, Barnes E Leon, Chetty Runjan, Perez-Ordoñez Bayrdo
Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada.
Histopathology. 2009 Jan;54(2):205-13. doi: 10.1111/j.1365-2559.2008.03198.x.
To describe seven cases of sinonasal seromucinous hamartoma.
The clinicopathological and immunohistochemical features of seven seromucinous hamartomas were analysed. There were four men and three women. Six lesions involved the posterior nasal septum and one the lateral wall. Size ranged from 6 to 40 mm. Four patients had no recurrences. One patient had local recurrences 24 and 60 months after diagnosis. The masses were covered by respiratory epithelium. Their stroma was oedematous to fibrous and contained invaginated respiratory epithelium forming glands and cysts, cysts with cuboidal to flat epithelium, and small serous glands, ducts and tubules with lobular and irregular haphazard patterns. One case had numerous glands surrounded by hyalinized basement membrane with features of respiratory epithelial adenomatoid hamartoma (REAH). One case had focal REAH-like changes. Both respiratory and serous components were positive for cytokeratin (CK) 7 and CK19. The serous component lacked myoepithelial cells when stained for CK14, p63, calponin and muscle-specific antigen in five cases.
Seromucinous hamartomas show a broader histopathological appearance than previously reported. The serous proliferation in these lesions lacks myoepithelial cells. The presence of occasional REAH-like features and common location in the posterior nasal septum suggest a spectrum from pure seromucinous hamartoma to REAH.
描述7例鼻窦浆液黏液性错构瘤。
分析7例浆液黏液性错构瘤的临床病理及免疫组化特征。患者中男性4例，女性3例。6个病变位于鼻中隔后部，1个位于侧壁。大小范围为6至40毫米。4例患者无复发。1例患者在诊断后24个月和60个月出现局部复发。肿物被呼吸道上皮覆盖。其间质从水肿到纤维性，含有内陷的呼吸道上皮形成腺体和囊肿、具有立方上皮至扁平上皮的囊肿，以及具有小叶状和不规则杂乱排列模式的小浆液性腺、导管和小管。1例有大量被透明化基底膜包围的腺体，具有呼吸道上皮腺样错构瘤（REAH）的特征。1例有局灶性REAH样改变。呼吸道和浆液成分的细胞角蛋白（CK）7和CK19均呈阳性。在5例中，当用CK14、p63、钙调蛋白和肌肉特异性抗原染色时，浆液成分缺乏肌上皮细胞。
浆液黏液性错构瘤的组织病理学表现比先前报道的更为广泛。这些病变中的浆液性增生缺乏肌上皮细胞。偶尔出现的REAH样特征以及在鼻中隔后部的常见位置提示了从单纯浆液黏液性错构瘤到REAH的谱系。
