Lisa Rooper, MD (2018)
Head and Neck pathologist
Director of Surgical Pathology
Associate Professor of Pathology
The Johns Hopkins Hospital
Florid invaginations of sinonasal epithelium? Don’t forget to look at the stroma!
Case 1 is respiratory epithelial adenomatoid hamartoma – admixed benign epithelium and stroma.
Case 2 is biphenotypic sinonasal sarcoma – malignant stroma entraps benign reactive epithelium.
⚠️遇到鼻腔鼻窦上皮出现“显著的”内陷现象？
⚠️别忘记观察间质！
病例1｜#呼吸道上皮腺瘤样错构瘤：良性上皮和间质混合存在。
病例2｜双表型鼻腔鼻窦肉瘤：良性反应性上皮“内陷于”恶性间质之中。
Head and Neck Tumours
(WHO 5, 2024)
Respiratory epithelial adenomatoid hamartoma (REAH) is an overgrowth of surface epithelium–derived medium-sized, ciliated glands surrounded by thickened basement membrane.
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呼吸道上皮腺瘤样错构瘤（REAH）是一种表面上皮过度生长，由增厚的基底膜包绕中等大小的纤毛上皮腺体组成。
REAH consists of a polypoid proliferation of medium-sized, elongated to rounded, branching glands that expand from the surface epithelium downward into the stroma. They are separated by varying amounts of oedematous or fibrous stroma, usually with chronic inflammation. The epithelium is of the pseudostratified, ciliated type and frequently shows mucinous metaplasia, which can be extensive, resulting in glands dilated by mucin. The epithelium may be atrophic, with a flattened appearance to the limited cell layers. The glands are typically surrounded by thickened, brightly eosinophilic basement membrane.
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呼吸道上皮腺瘤样错构瘤（REAH）：息肉样增生性病变，由中等大小、呈长梭形至圆形的分支状腺体构成，这些腺体从表面上皮向下延伸至间质内。腺体之间间隔着数量不等的水肿性或纤维性间质，通常伴有慢性炎症。
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腺体上皮为假复层纤毛上皮，常出现黏液化生（有时范围较广泛），可因黏液潴留导致腺体扩张。部分上皮可能呈现萎缩性改变，细胞层数减少且形态扁平。
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腺体周围通常环绕着增厚的、明显嗜酸性的基底膜。
Polypoid mass consisting of elongated or ovoid glands, descending from the surface.
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由从表面上皮向下延伸的长梭形或卵圆形腺体形成息肉样肿块。
Marked stromal hyalinization with flattening of the epithelium is common.
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常见间质明显的玻璃样及扁平的上皮。
Glands are lined by ciliated epithelium with mucinous cells, enveloped by thick, hyalinized stroma. There is intervening chronic inflammation.
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腺体内衬含黏液细胞的纤毛上皮，周围包裹着增厚的玻璃样变间质。
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间质中见慢性炎症细胞浸润。
In most cases, collections of small seromucinous glands are also noted between the larger glands.
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大多数病例，在较大腺体之间可见小的浆黏液性腺体聚集。