Cao Zhiwei, Gu Zhaowei, Bian Zhigang, Shu Hong
Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang, 110004, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2010 Jun;24(11):507-10.
To describe five rare cases of bilateral olfactory clefts respiratory epithelial adenomatoid hamartoma (REAH), and investigate the clinicopathologic features in REAH.
Five cases with REAH were reported and the relevant literatures were reviewed. All the cases were confirmed by pathology.
The chief complaint in 4 cases when visited was nasal obstruction and rhinorrhea, with or without hyposmia and headache. Another was discomfortable of head-facial region, sometimes with pus discharge and blood in nasal discharge. Polypoid neoplasms can be seen in nasal meatus of the 5 cases. Endoscopic sinus surgery was utilized to eliminate foci in 5 cases. All REAH foci located in bilateral olfactory clefts areas, four of which appeared polypoid changes,one appeared obvious inflammatory edema. All of them presented as wide-based lesion with tenacious quality compared to polyps. Histologically, these lesions were characterized by a glandular proliferation lined by ciliated respiratory epithelium originated from the surface epithelium, and the glands surround into round or oval, with various sizes and separated by stromal tissue.
It is possible to continue developing after operation, if REAH is not completely resected. Complete resection of lesions is the key to treatment success for this entity in endoscopic sinus surgery. Although REAH arising from the rhino sinusal region is very rare, rhinolaryngologists must know this entity in order to differentiate it from inverted papilloma and adenocarcinoma.
描述5例双侧嗅裂呼吸上皮腺瘤样错构瘤(REAH)的罕见病例,并探讨REAH的临床病理特征。
报告5例REAH病例并复习相关文献。所有病例均经病理证实。
4例患者就诊时的主要症状为鼻塞、流涕,伴或不伴有嗅觉减退及头痛。另1例为头面部不适,有时有脓性分泌物及涕中带血。5例患者鼻道内均可见息肉样肿物。5例均采用鼻内镜鼻窦手术清除病灶。所有REAH病灶均位于双侧嗅裂区,其中4例呈息肉样改变,1例有明显炎性水肿。与息肉相比,所有病灶均表现为基底较宽、质地坚韧。组织学上,这些病灶的特征为起源于表面上皮的纤毛呼吸上皮衬覆的腺管增生,腺管呈圆形或椭圆形,大小不一,被间质组织分隔。
如果REAH未完全切除,术后有可能继续发展。在内镜鼻窦手术中,完整切除病灶是该疾病治疗成功的关键。尽管起源于鼻鼻窦区域的REAH非常罕见,但耳鼻喉科医生必须了解这种疾病,以便将其与内翻性乳头状瘤和腺癌相鉴别。