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Cardinale L, Basile D, Fraccalini T, Volpicelli G, Busso M. Why do a lung biopsy for benign lesions? Minerva Surg 2024; 79:443-447. [PMID: 38953756 DOI: 10.23736/s2724-5691.24.10192-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND Transthoracic needle biopsy of lung lesions is a well-established procedure for the diagnosis of lung lesions. The literature focuses on the diagnosis of malignant lesions with an often reported accuracy rate of more than 90%. Experience showed that biopsy can identify sometimes incidentally, also benign lesions. There are many reasons why a biopsy is performed for a "benign lesion." First of all, it may be an unexpected diagnosis, as some benign pathologies may have misleading presentations, that are very similar to lung cancer, otherwise the reason is only to make a diagnosis of exclusion, which leads to the benign pathology already being considered in the differential diagnosis. METHODS This study was designed as a retrospective single-center study. We selected from our database all the lung biopsies performed under CT guidance, from 2015 to 2019 and retrospectively analysed the histological data. We selected only benign lesions describing the imaging feature and differential diagnosis with lung malignancy. RESULTS In our patient population, among the 969 of them that underwent biopsy, we identified 93 benign lesions (10%). Hamartomas, granulomas, slow-resolving pneumonia and cryptogenic organizing pneumonia are the pathologies that most frequently can misinterpratedas lung cancer. CONCLUSIONS In this brief report we want to show the percentage and type of benign lesions that are found in our lung trans-thoracic biopsy population. Among these, we identified the three most frequent benign lesions that most frequently enter the differential diagnosis with lung malignant lesions describing the classic and atypical imaging findings.
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Affiliation(s)
- Luciano Cardinale
- Unit of Radiology, San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy -
| | - Domenico Basile
- Department of Diagnostic Services, ASL TO3, Ospedale degli Infermi, Rivoli, Turin, Italy
| | - Thomas Fraccalini
- Department of Medical and Oncology Area, Division of Geriatrics and Gerontology, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Giovanni Volpicelli
- Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Marco Busso
- Department of Diagnostic Services, ASL TO3, Ospedale degli Infermi, Rivoli, Turin, Italy
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Fiorelli A, D'Andrilli A, Carlucci A, Vicidomini G, Argento G, Trabalza Marinucci B, Ardissone F, Rapanà R, Sobrero S, Carbognani P, Ventura L, Bocchialini G, Ragusa M, Tassi V, Sollitto F, Loizzi D, Ardò NP, Anile M, Puma F, Rendina EA, Venuta F, Serra N, Santini M. Pulmonary Hamartoma Associated With Lung Cancer (PHALC Study): Results of a Multicenter Study. Lung 2021; 199:369-378. [PMID: 34302497 PMCID: PMC8416857 DOI: 10.1007/s00408-021-00460-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
Purpose Pulmonary hamartoma is the most common benign tumor of the lung. We analyzed a 20-year historical series of patients with pulmonary hamartoma undergoing surgical resection, aiming to evaluate the characteristics, the outcomes, and the association between hamartoma and lung cancer. Methods It was a retrospective multicenter study including the data of all consecutive patients with pulmonary hamartoma undergoing surgical resection. The end-points were to evaluate: (i) the characteristics of hamartoma, (ii) outcomes, and (iii) whether hamartoma was a predictive factor for lung cancer development Results Our study population included 540 patients. Upfront surgical or endoscopic resection was performed in 385 (71%) cases while in the remaining 155 (29%) cases, the lesions were resected 20 ± 3.5 months later due to increase in size. In most cases, lung sparing resection was carried out including enucleation (n = 259; 48%) and wedge resection (n = 230; 43%) while 5 (1%) patients underwent endoscopic resection. Only two patients (0, 2%) had major complications. One patient (0.23%) had recurrence after endoscopic resection, while no cases of malignant degeneration were seen (mean follow-up:103.3 ± 93 months). Seventy-six patients (14%) had associated lung cancer, synchronous in 9 (12%) and metachronous in 67 (88%). Only age > 70-year-old (p = 0.0059) and smokers > 20 cigarettes/day (p < 0.0001) were the significant risk factors for lung cancer. Conclusion PH was a benign tumor, with no evidence of recurrence and/or of malignant degeneration after resection. The association between hamartoma and lung cancer was a spurious phenomenon due to common risk factors.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Via Pansini, 7, I-80138, Naples, Italy.
| | - Antonio D'Andrilli
- Thoracic Surgery, Sant'Andrea Hospital, Università La Sapienza, Rome, Italy
| | - Annalisa Carlucci
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Via Pansini, 7, I-80138, Naples, Italy
| | - Giovanni Vicidomini
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Via Pansini, 7, I-80138, Naples, Italy
| | - Giacomo Argento
- Thoracic Surgery, Sant'Andrea Hospital, Università La Sapienza, Rome, Italy
| | | | - Francesco Ardissone
- Department of Oncology, Thoracic Surgery Unit, San Luigi Hospital, University of Torino, Orbassano, Italy
| | - Roberta Rapanà
- Department of Oncology, Thoracic Surgery Unit, San Luigi Hospital, University of Torino, Orbassano, Italy
| | - Simona Sobrero
- Department of Oncology, Thoracic Surgery Unit, San Luigi Hospital, University of Torino, Orbassano, Italy
| | - Paolo Carbognani
- Medicine and Surgery, Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Luigi Ventura
- Medicine and Surgery, Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Giovanni Bocchialini
- Medicine and Surgery, Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Mark Ragusa
- Division of Thoracic Surgery, S. Maria di Terni Hospital, University of Perugia Medical School, Terni, Italy
| | - Valentina Tassi
- Division of Thoracic Surgery, S. Maria di Terni Hospital, University of Perugia Medical School, Terni, Italy
| | | | | | | | - Marco Anile
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | | | | | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - Nicola Serra
- Statistic Unit, Department of Public Health, University of Federico II, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Via Pansini, 7, I-80138, Naples, Italy
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Chatzopoulos K, Johnson TF, Boland JM. Clinical, Radiologic, and Pathologic Characteristics of Pulmonary Hamartomas With Uncommon Presentation. Am J Clin Pathol 2021; 155:903-911. [PMID: 33258901 DOI: 10.1093/ajcp/aqaa193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To investigate the clinicopathologic and radiologic features of pulmonary hamartomas (PHs) with uncommon clinical presentation. METHODS A retrospective clinicopathologic and radiologic review was performed for patients diagnosed (1999-2019) with multiple hamartomas, lesions arising adjacent to a coexisting pulmonary malignancy, and tumors with predominantly extrapulmonary localization. RESULTS Of 979 patients diagnosed with PHs, 6 (0.6%) had multiple hamartomas, 4 (0.4%) had hamartomas adjacent to lung adenocarcinoma, and 2 (0.2%) had large mediastinal masses. Patients with multiple lesions had a median age of 65 years and mean tumor size of 0.9 cm; 1 patient had 3 hamartomas, and 5 patients had 2. Lesions next to adenocarcinomas had a mean size of 1.4 cm, and affected patients had a median age of 69 years. Predominantly mediastinal PHs, diagnosed in a 63-year-old woman and a 68-year-old man, measured 4.1 to 6 cm and were connected to the lung. All lesions were solid on imaging with absence of definitive fat or calcification, concerning for granuloma or malignancy. All cases had typical histology of PH, although one of the mediastinal tumors had an unusual amount of epithelial hyperplasia. CONCLUSIONS PHs can be clinically and radiologically challenging to diagnose. Histopathologic examination of biopsies and resection specimens is diagnostically crucial in this setting.
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Altuntas B, Demirci E, Yildirim Z, Aydin Y, Eroglu A. A child with multiple pulmonary hamartomas initially thought to be metastasis of Wilms' tumour. Br J Hosp Med (Lond) 2021; 82:1-3. [PMID: 33792380 DOI: 10.12968/hmed.2020.0374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bayram Altuntas
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Elif Demirci
- Department of Pathology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Zuhal Yildirim
- Department of Pediatrics, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Yener Aydin
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Atilla Eroglu
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey
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Wang W, Song J, Shi J, Hu H, Wu Y, Yan J, Wu L, Chen Q. Slight uptake of 18F-FDG on positron emission tomography in pulmonary hamartoma: A case report. Oncol Lett 2015; 10:430-432. [PMID: 26171045 DOI: 10.3892/ol.2015.3245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 04/17/2015] [Indexed: 11/06/2022] Open
Abstract
The present study reports the case of a 77-year-old female that was asymptomatic at presentation and was found to possess a lesion that was incidentally identified on a computed tomography (CT) scan. The CT scan revealed a non-homogeneous, hypodense, non-lobulated solid mass, ~1.2 cm in diameter, in the left upper lobe of the lung that demonstrated minimal contrast enhancement. The following CT scan was performed only two years later. This scan revealed that the non-homogeneous round mass had increased in size to ~1.7 cm in diameter, and possessed an irregular margin, in addition to being slightly lobulated with no calcification or fat. Combined positron emission tomography and CT revealed a lobulated mass that was ~1.9 cm in diameter, demonstrating an irregular margin with involvement of the mediastinal pleura. Slight uptake of 18F-fluorodeoxyglucose was also detected. The final histological diagnosis was pulmonary hamartoma.
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Affiliation(s)
- Weihua Wang
- Department of Respiratory Medicine, Jiangshan People's Hospital, Jiangshan, Zhejiang 324100, P.R. China
| | - Jia Song
- Department of Respiratory Oncology, The 117th Hospital of PLA, Hangzhou, Zhejiang 310013, P.R. China
| | - Jianguo Shi
- Department of Nuclear Medicine, The 117th Hospital of PLA, Hangzhou, Zhejiang 310013, P.R. China
| | - Huizhen Hu
- Department of Respiratory Oncology, The 117th Hospital of PLA, Hangzhou, Zhejiang 310013, P.R. China
| | - Yuquan Wu
- Department of Thoracic Surgery, The 117th Hospital of PLA, Hangzhou, Zhejiang 310013, P.R. China
| | - Jie Yan
- Department of Respiratory Oncology, The 117th Hospital of PLA, Hangzhou, Zhejiang 310013, P.R. China
| | - Lijun Wu
- Department of Respiratory Oncology, The 117th Hospital of PLA, Hangzhou, Zhejiang 310013, P.R. China
| | - Qingyong Chen
- Department of Respiratory Oncology, The 117th Hospital of PLA, Hangzhou, Zhejiang 310013, P.R. China
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Sakamoto K, Ando K, Noma D. Pulmonary chondromatous hamartoma with pleural dissemination: report of a case. Surg Today 2014; 45:1197-9. [PMID: 25099992 DOI: 10.1007/s00595-014-1006-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 07/11/2014] [Indexed: 10/24/2022]
Abstract
We herein describe a very rare case of pulmonary hamartoma with pleural dissemination. A 77-year-old male was referred to our department for a further investigation of an abnormal chest radiograph. Chest computed tomography showed a 15 mm nodule in the left lung with small pleural nodules. Thoracoscopic resection of the nodules was performed, as the possibility of malignancy could not be ruled out. The intraoperative findings revealed a white nodule with a lumpy surface in the left lower lobe that had penetrated the visceral pleura. Several smaller nodules were found on the pleural surface. Pathologically, the pulmonary and pleural nodules were chondromatous hamartomas.
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Affiliation(s)
- Kazuhiro Sakamoto
- Department of Respiratory Surgery, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama, 245-8575, Japan,
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Morresi-Hauf AT, Wagner K, Weber N, Lindner M. [Giant hamartoma of the lung]. DER PATHOLOGE 2011; 33:146-51. [PMID: 21964966 DOI: 10.1007/s00292-011-1531-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hamartomas are the most common benign tumors of the lungs and usually present as solitary intraparenchymal lesions a few centimeters in diameter which are detected radiologically as an incidental finding. This article reports on a case of a giant pulmonary hamartochondroma 29 cm in diameter, which impressed preoperatively and intraoperatively as an extrapulmonary neoplasm. The detection of smaller mesenchymal neoplastic lesions in the lungs and pleura is a further special feature of this case.
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Affiliation(s)
- A T Morresi-Hauf
- Institut für Pathologie, Asklepios Fachkliniken München-Gauting, Robert-Koch-Allee 2, 82131, Gauting, Deutschland.
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