Clinical Analysis And Pathological Characteristics Of Epithelial Adenomatous Hamartoma Of Nasal Respiratory Tract

ObjectiveTo investigate the clinical manifestations,imaging features and pathological characteristics of Respiratory epithelial adenomatoid hamartoma(REAH),with the aim of providing theoretical support and clinical guidance for the diagnosis and treatment of REAH.MethodsThe clinical data of 109 patients with pathologically confirmed nasal and respiratory epithelial adenomatous hamartoma who were admitted to the Department of Otorhinolary ngology Head and Neck Surgery of Qingdao University Affiliated Hospital from November2013 to September 2020 were retrospectively analyzed.A total of 77 REAH patients whose tumors originated from bilateral olfactory clefts were included in the REAH group,and 60 patients with chronic sinusitis and nasal polyps who had undergone surgery and who had bilateral olfactory cleft nasal polyps were included in the nasal polyp group(NPS group).60 other nasal surgery patients(including pituitary tumors,nasal vestibular cysts,etc.)with no lesions in the olfactory cleft area were included as the control group.The clinical manifestations,preoperative imaging data and pathological characteristics of the olfactory cleft lesions of the above patients were analyzed.The maximum olfactory clefts width(MOC)and total nasal width(TN)of the three groups were measured on the coronal CT of the sinuses,the ratio of MOC and TN was calculated,and the olfactory clefts in the REAH group and the NPS group were measured.The CT value of the fissure area was analyzed statistically.Compare the clinical characteristics of REAH group and NPS group,analyze their differences,select pathological sections of olfactory cleft tumors of patients in REAH and NPS groups,perform HE staining and immunohistochemical staining,and describe the differences in histopathological characteristics between the two.The patients in the REAH group were followed up after surgery,and their treatment and prognosis were summarized.ResultsA total of 109 patients were enrolled,including 82 males and 27 females,male:female=3.04:1,aged 16 to 83 years,with a median age of 54 years.The duration of the disease is between January and 30 years,with an average duration of 4.82 years.The main symptoms include nasal congestion,decreased or lost sense of smell,runny nose,headache,dizziness,sneezing and runny nose,sleep snoring,etc.Among them,94 patients had chronic rhinosinusitis with nasal polyps(86.24%),26 patients(23.85%)with tumors involved unilateral nasal cavity,and 83 patients(76.15%)with bilateral nasal cavity.REAH is located at the rear end of the nasal septum,the middle nasal passage and the olfactory cleft area and extends to the sinuses.A small part only occurs such as maxillary sinus,frontal sinus,ethmoid sinus and middle turbinate.There was no significant difference in the probability of patients with allergic diseases between the REAH group and the NPS group(P=0.067),and the ratios of patients with a history of surgery in the REAH group was significantly higher than that in the NPS group(P<0.001).The MOC and MOC/TN ratios of the REAH group were significantly higher than those of the NPS group and the control group,and the difference was statistically significant(P<0.05).The NPS group had no statistically significant difference(P>0.05),which compared with the control group,.There was no significant difference in the total width of the nasal cavity between patients(P>0.05),and there was no significant difference in the CT value of the olfactory cleft between the REAH group and the NPS group(P>0.05).The typical pathological change of REAH is the hyperplasia of lining ciliated epithelial glands.The glands are round or oval in different sizes,separated by some interstitial tissues,and the interstitium has sclerosis changes.The main difference from nasal polyps is the number of glandular hyperplasias and gland morphology.The treatment of REAH is surgical resection.All patients were followed up for 7 months to82 months after surgery.4 cases recurred after surgery,with a recurrence rate of 3.67%.The improved sense of smell accounted for 85.45%.Conclusion1.REAH is a benign tumor of the nasal cavity,which is not uncommon and occurs mostly in the bilateral olfactory fissures,followed by the posterior end of the nasal septum.2.CT examination is the preferred imaging test for REAH,and the widening of the olfactory fissure area bilaterally is its characteristic imaging manifestation.3.The typical pathological changes of REAH are benign abnormal proliferation of glands in the lesion tissue,which can be distinguished from nasal polyp tissue.4.The treatment of REAH is complete surgical excision,and most patients have improved olfactory function after surgery compared to the preoperative period.