雙側嗅裂呼吸道上皮腺瘤樣錯構瘤──病例報告

Respiratory Epithelial Adenomatoid Hamartoma of the Bilateral Olfactory Cleft–Case Report

發生在鼻腔的錯構瘤不常見，且絕大多數是源自呼吸道上皮的腺瘤樣錯構瘤（Respiratory Epithelial Adenomatoid Hamartoma, REAH）。其最常見的發生位置在鼻中隔後部，從嗅裂長出來的相對稀少。REAH確切的成因還不是很清楚，推測可能是長期發炎的過程所致。我們經歷一位61歲男性，主訴長期鼻塞以及嗅覺低下。經內視鏡檢查發現雙側嗅裂被息肉堵塞，予以類固醇噴劑治療數月未果，遂安排手術治療。術前電腦斷層顯示息肉局限於雙側嗅裂，術後組織鏡檢可見大小不一的腺體增生並且往黏膜下陷入。這些腺體內襯複層纖毛呼吸道上皮以及杯狀細胞，被增厚且富含嗜酸性球的基底膜所包繞。根據上述病理特徵診斷為呼吸道上皮的腺瘤樣錯構瘤。REAH與鼻息肉巨觀下型態相類，應為鼻息肉的鑑別診斷之一。

Hamartomas are uncommon in the nasal cavity. The majority of hamartomas are respiratory epithelial adenomatoid hamartoma (REAH) originates from the respiratory epithelium. The most frequently affected location is the posterior part of the nasal septum, while growth from the olfactory cleft is relatively rare. The exact etiology of REAH is unclear, but it may be induced by a long-term inflammatory process. We examined a 61-year-old man complaining of nasal obstruction with hyposmia for a long time. Under endoscopic examination, the bilateral olfactory cleft was blocked by polyps. He was treated with steroid sprays for several months but the symptoms didn’t improve, so surgical treatment was considered. Preoperative computed tomography showed the polyps were confined to the bilateral olfactory clefts. The pathologic findings showed proliferation of various sized glands that invaginated into the submucosa. These glands were lined with stratified ciliated respiratory epithelium and goblet cells, enveloped by a thickened basement membrane, which was infiltrated by eosinophils. According to the above features, we made the diagnosis of REAH. REAH is similar to the nasal polyp in appearance and should be a differential diagnosis of nasal polyposis.