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Fan X, Breaux B, Leonards L, Mirza R. A rare case of asymptomatic giant pulmonary hamartoma. Diagn Pathol 2024; 19:87. [PMID: 38909245 PMCID: PMC11193182 DOI: 10.1186/s13000-024-01506-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/02/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Pulmonary hamartomas are benign lung lesions. Histopathologically, pulmonary hamartoma is composed of varying amounts of mesenchymal elements, including chondroid tissue, mature adipose tissue, fibrous stroma, smooth muscle, and entrapped respiratory epithelium. Most pulmonary hamartoma cases are asymptomatic and found incidentally during imaging. They usually appear as well-circumscribed lesions with the largest dimension of less than 4 cm. Asymptomatic giant pulmonary hamartomas that more than 8 cm are rare. CASE PRESENTATION In the current case report, a 12.0 × 9.5 × 7.5 cm lung mass was incidentally noticed in a 59-year-old female during a heart disease workup. Grossly, the lesion was lobulated with pearly white to tan-white solid cut surface and small cystic areas. Microscopically, representative tumor sections demonstrate a chondromyxoid appearance with relatively hypocellular stroma and entrapped respiratory epithelium at the periphery. No significant atypia is noted. No mitosis is noted, and the proliferative index is very low (< 1%) per Ki-67 immunohistochemistry. Mature adipose tissue is easily identifiable in many areas. Histomorphology is consistent with pulmonary hamartoma. A sarcoma-targeted gene fusion panel was further applied to this case. Combined evaluation of microscopic examination and sarcoma-targeted gene fusion panel results excluded malignant sarcomatous transformation in this case. The mediastinal and hilar lymph nodes are histologically benign. After surgery, the patient had an uneventful postoperative period. CONCLUSIONS Giant pulmonary hamartoma is rare; our case is an example of a huge hamartoma in an asymptomatic patient. The size of this tumor is concerning. Thus, careful and comprehensive examination of the lesion is required for the correct diagnosis and to rule out co-existent malignancy.
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Affiliation(s)
- Xiaoming Fan
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Barry Breaux
- Pathology Department, North Oaks Medical Center, North Oaks Health System, Hammond, LA, USA
| | - Laura Leonards
- North Oaks Imaging Associates, North Oaks Health System, Hammond, LA, USA
| | - Rusella Mirza
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
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Borg M, Løkke A, Olsen KE, Hilberg O. Large pulmonary hamartoma: unusual presentation of a common abnormality. BMJ Case Rep 2023; 16:e255064. [PMID: 37788918 PMCID: PMC10551927 DOI: 10.1136/bcr-2023-255064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Affiliation(s)
- Morten Borg
- Department of Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark
| | - Karen Ege Olsen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Ole Hilberg
- Department of Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark
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Fernández-González AM, García FJG, Chávez DSP, López ER, Leiva-Cepas F, Álvarez A. Lung Transplantation for Multiple Giant Hamartomas: First Case Report and Review of the Literature. Transplant Proc 2022; 54:2506-2508. [DOI: 10.1016/j.transproceed.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/02/2022] [Indexed: 11/05/2022]
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Hamartochondroma Pleural Lesion Mimicking Liposarcoma: A Case Report. Curr Oncol 2022; 29:3489-3493. [PMID: 35621671 PMCID: PMC9140095 DOI: 10.3390/curroncol29050281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 12/05/2022] Open
Abstract
Heterogeneous masses developing in the pleural cavity are most often malignant and can pose diagnostic challenges. Fibrous tumors of the pleura, liposarcoma, thymoma or lipoma most frequently affect this anatomic area. Surgical exploration and resection are often mandatory to make the definitive diagnosis. We report the case of a 54-year-old women who presented with an epigastric and right sub costal pain. A complete preoperative workup revealed a large tissular and fatty mass in the right costo-diaphragmatic angle suggestive of liposarcoma. Surgical resection resulted in the surprising diagnosis of hamartochondroma.
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Review of 30 pulmonary hamartoma cases: Follow-up and treatment. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.904171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ng BH, Ban Yu-Lin A, Low HJ, Faisal M. Cryodebulking of endobronchial hamartoma via fibreoptic bronchoscopy and literature review. BMJ Case Rep 2020; 13:13/8/e235316. [PMID: 32843453 DOI: 10.1136/bcr-2020-235316] [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: 11/04/2022] Open
Abstract
Endobronchial hamartoma is a rare tumour. We report a 65-year-old woman with a history of recurrent pneumonia. Bronchoscopy revealed a 1 cm endobronchial mass obstructing the left upper lobe bronchus. Histopathological examination was consistent with a pulmonary hamartoma. This lesion was successfully debulked endoscopically with the use of a flexible cryoprobe without any complications. This case highlights both the importance of investigating recurrent pneumonia and the usefulness of endoscopic recanalisation in an obstructed segmental bronchus.
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Affiliation(s)
- Boon Hau Ng
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Andrea Ban Yu-Lin
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hsueh Jing Low
- Anaesthesiology and Intensive Care, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohamed Faisal
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Li Y, Zheng D, Zuo M, Li Y, Zhang H. Chondromesenchymal hamartomas in a 24-year-old male mimicking a posterior mediastinal tumor and a 5-month-old boy with postoperative disseminated intravascular coagulation: two case reports. Diagn Pathol 2020; 15:53. [PMID: 32398154 PMCID: PMC7218570 DOI: 10.1186/s13000-020-00940-0] [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: 08/06/2019] [Accepted: 02/25/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Chondromesenchymal hamartoma of the chest wall is a rare, benign disease that usually presents at birth or in early infancy. It typically involves one or more ribs, forming a unilateral or bilateral extrapleural mass. Patients may be asymptomatic or complain of mild respiratory distress depending on tumor size and location. To the best of our knowledge, only two of the approximately 100 cases reported so far are adults. CASE PRESENTATION We present two cases of chondromesenchymal hamartoma. The first case involved the left fifth rib in a 24-year-old male, in close proximity to the fifth vertebral body in the left posterior mediastinum, mimicking a posterior mediastinal tumor on imaging. The tumor was excised via thoracoscopy and the patient had an uneventful postoperative course. The second case was that of a 5-month-old boy, who had a tumor involving the left fifth and sixth ribs which caused thoracic cage collapse. Following en bloc resection of the tumor and the involved rib segments, the patient was transferred to the intensive care unit for treatment of pulmonary infection and disseminated intravascular coagulation (DIC). He was discharged from the hospital in stable condition 11 days later. On histopathology, the tumor was found to be a chondromesenchymal hamartoma with immature spindle-shaped mesenchymal cells, plate-like hyaline cartilage, areas of woven bone formation, endochondral ossification and calcification, osteoclastic giant cells, and secondary aneurysmal bone cysts. CONCLUSIONS Although the presently reported cases have morphological characteristics similar to previously reported ones, they had distinct radiological and clinical characteristics. Patient 1 is only the third report of an adult with chondromesenchymal hamartoma. His case was characterized by its radiological appearance mimicking a posterior mediastinal tumor. Patient 2 represents the first documentation of DIC as a postoperative complication following excision of a chondromesenchymal hamartoma. We present these two cases to provide clinicopathological insights regarding this extremely rare tumor that are relevant to both pathologists and clinicians.
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Affiliation(s)
- Yue Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Danyang Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, Dongfeng Road, Yuexiu District, No. 651, Guangzhou, 510060, China
| | - Min Zuo
- Department of Pathology, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Yang Li
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, China. .,Department of Pathology, Guangzhou Concord Cancer Center, Guangzhou, 510045, China.
| | - Huizhong Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. .,Department of Pathology, Sun Yat-Sen University Cancer Center, Dongfeng Road, Yuexiu District, No. 651, Guangzhou, 510060, China.
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Ganesan N, Gurusamy U. Morphologic Spectrum of Undetermined Causes of Hemoptysis- A Pathologist's Role. Turk Patoloji Derg 2020; 36:237-245. [PMID: 32692401 PMCID: PMC10510595 DOI: 10.5146/tjpath.2020.01495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Hemoptysis is the expectoration of blood or blood-streaked sputum from the tracheobronchial tree. The etiology may derive from nonneoplastic conditions such as infections, chronic pulmonary diseases, and vasculitis or neoplastic causes. Sometimes a definitive cause for hemoptysis cannot be found after ample diagnostic workup. The role of biopsy in such cases is to help the clinician in arriving at the final diagnosis. Diffuse alveolar hemorrhage is the main histopathological finding in hemoptysis and it appears with diffuse chest infiltrates radiologically. MATERIAL AND METHOD A retrospective study of 2 years duration was conducted to identify the morphological spectrum of diseases presenting with hemoptysis. A total of 243 lung biopsies obtained by various methods were retrieved in this study period and 20 cases with hemoptysis of undetermined etiology were detected. RESULTS Based on imaging and histopathology findings, the etiological causes of hemoptysis were divided into hemoptysis with and without capillaritis or due to tumor/tumor-like lesions and due to miscellaneous conditions. The most common etiology was vasculitis followed by infections. CONCLUSION Histopathology helps to detect the etiology, particularly in cases of hemoptysis due to non-immunologic causes. In immunologic cases, histopathological findings may support the diagnosis in correlation with the clinical/imaging features.
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Affiliation(s)
- Nidhya Ganesan
- Department of Pathology, PSG Institute of Medical Sciences and Research, Tamilnadu, India
| | - Umamaheswari Gurusamy
- Department of Pathology, PSG Institute of Medical Sciences and Research, Tamilnadu, India
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