Surgical treatment and outcome of pulmonary hamartoma: a retrospective study of 20-year experience

A rare cause of bronchial obstruction: Endobronchial hamartoma case report

Most of the pulmonary endobronchial lesions are malignant in origin. In rare instances, benign lesions such as endobronchial hamartoma may be the cause of the endobronchial tree obstruction. We present the case of a 57-year-old male patient from North Africa who presents with a history of a 5-month cough. Imaging, particulary CT scan, showed a mass on the right intermediate bronchus whose radiological characteristics are consistent with hamartoma. A biopsy of the mass obtained via bronchoscopy revealed chronic inflammation with no evidence for malignancy. The patient was treated surgically, and anatomopathology confirmed the diagnosis of hamartoma.

A rare case of asymptomatic giant pulmonary hamartoma

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.

Pulmonary leiomyosarcoma arising in pulmonary hamartoma: an exceptional occurrence in a rare tumor

A solitary peripheral lung nodule was found in the left lung of a 52-year-old man. It was located in the lower lobe and measured 18.5 cm of major axis on chest computed tomography. A tru-cut core biopsy was obtained and a proliferation of bland, monomorphic, spindle cells in interlacing fascicles was observed. Accordingly, a surgical resection of the neoplasm was subsequently carried out. Macroscopically, the tumor appeared as a well-circumscribed nodule with a firm and whitish cut surface. Histologically, the neoplasm was predominantly composed of bland and monomorphic spindle cells, with a predominantly fascicular growth pattern, in which many tubular and cleft-like spaces of entrapped normal respiratory epithelium were involved. Myxoid change, stromal hyalinization and scattered bizarre mononucleated and multinucleated cells were also observed. Based on clinico-morphological, immunophenotypical and molecular features, we made a diagnosis of malignant transformation of pulmonary adenoleiomyomatous hamartoma into pulmonary leiomyosarcoma. As far as we know, this is the first described case of this exceptionally rare occurrence in an already rare neoplasm.

Pulmonary placental transmogrification: a difficult pattern in differential diagnosis of pulmonary hamartomas from a tertiary care hospital in Turkey

OBJECTIVE

Pulmonary placental transmogrification (PT) is a benign lesion curable by resection, represented by an unusual peculiar morphological variation including placentoid bullous change in the pulmonary hamartoma. In this retrospective study, we aimed to examine the histopathological features of pulmonary hamartomas in lung, to evaluate the different histological components, especially PT, and to investigate importance of PT pattern and its relationship with other clinicopathological features.

METHODS

Thirty-five cases of pulmonary hamartomas were recruited from the records between 2001 and 2021, divided into two groups according to presence of PT, as PT (-) and PT (+) in pathological examination.

RESULTS

77.1% of all patients were male. There was no significant difference between the two groups in terms of age, sex, comorbidity, presence of symptoms, tumor localization, and radiological findings (P > 0.05). Pulmonary hamartomas were resected totally from 28 patients (80%). Five of these patients (17.9%) had PT components in resection materials with varying degree between 5 and 80%, and all were from male patients. Examination with frozen sections were performed in 15 PT (-) and 5 PT (+) patients but diagnosis with frozen sections was not achieved in any of PT (+) patients. Most of materials included chondroid components (52.22 ± 29.7%) in both groups (P < 0.05).

CONCLUSION

The placental papillary projections are available patterns associated with a pulmonary hamartoma and these projections observed especially in frozen sections are very crucial to recognize PT pattern in hamartomas, as they can result in confusions in differential diagnosis of malignities.

An Indonesian female with pulmonary cystic hamartoma: a case report and literature review

Pulmonary cystic hamartoma is a rare benign cystic mass of the lung with clinical symptoms and radiological features that are not typical.

Case presentation

A 43-year-old Indonesian female complained of chest and right shoulder pain, especially in the right clavicle. The patient underwent a chest X-ray and computed tomography scan thorax contrast, resulting in an anterior mediastinal tumor. The patient underwent wedge resection, and anatomical pathology showed pulmonary cystic hamartoma. The patient experienced postsurgery improvement.

Discussion

Pulmonary cystic hamartoma does not have typical signs and symptoms. Pulmonary hamartoma diagnosis cannot be confirmed until a pathology anatomy examination is performed. Wedge resection is the first choice to treat pulmonary cystic hamartoma.

Conclusion

Pulmonary cystic hamartoma is diagnosed with examination from pathology anatomy.

Tracheal Hamartoma: A Case Report

Hamartoma is the most frequently observed benign lung tumor, but its tracheal form is still exceptionally encountered. Cough, dyspnea, hemoptysis, and chest pain are all possible symptoms of tracheal hamartoma. The non-specific symptoms may also lead to a delayed diagnosis, and while the choice of treatment varies depending on the size and location of the lesion, conservative treatments remain strongly recommended. This report presents the case of a 57-year-old male who presented to our department with inspiratory dyspnea. Clinico-radiological data and bronchoscopy revealed a benign tracheal tumor of the lipomatous hamartoma type. The patient underwent a tumor resection by rigid bronchoscopy with satisfactory clinical results.

Pulmonary Hamartomas: A Single-Center Analysis of 59 Cases

OBJECTIVE

This study investigated the clinical, radiological, and surgical treatment results of patients who underwent surgical treatment for pulmonary hamartomas.

MATERIALS AND METHODS

Fifty-nine consecutive patients who underwent surgical treatment for pulmonary hamartomas in our clinic between January 2001 and February 2021 were analyzed retrospectively.

RESULTS

Forty-three out of 59 (72.9%) of the cases were male and 16 (27.1%) were female. The average age was 52.0 ± 15.0 (between 5 years and 80 years). While pulmonary hamartoma was in the form of a solitary pulmonary nodule in 55 (93.2%) of the cases, there were multiple lesions in 4 (6.8%) cases. Simultaneous gastric adenocarcinoma was detected in 1 patient. One case had been operated on for Wilms tumor. Twenty-two (37.3%) of the cases were asymptomatic and were detected incidentally. Locations of pulmonary hamartomas were 18 (29.0%) in the left lower lobe, 16 (25.8%) in the right upper lobe, 12 (19.4%) in the right lower lobe, 9 (14.5%) in the left upper lobe, and 7 (11.3%) in the right middle lobe. The mean lesion diameter was 22.0 ± 9.5 mm (between 10 mm and 56 mm). Mild to moderate fluorodeoxyglucose (FDG) uptake was observed in 11 of 15 cases that were evaluated with positron emission tomography/computed tomography. Surgically, 44 (74.6%) patients underwent wedge resection, 13 (22.0%) patients underwent enucleation and two (3.4%) patients underwent lobectomy. Perioperative morbidity and mortality were not observed in any of the cases. The cases were followed up for an average of 40.6 ± 38.7 months (between 1 month and 151 months). No recurrence was observed in any of the cases during follow-up.

CONCLUSION

Pulmonary hamartomas are usually detected incidentally and as a solitary pulmonary nodule. Although radiological findings provide important information, a definitive diagnosis is usually made during surgery. Parenchyma-sparing surgery should be preferred in these cases whenever possible.

Hamartochondroma Pleural Lesion Mimicking Liposarcoma: A Case Report

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.

Large cystic-solid pulmonary hamartoma: A case report

BACKGROUND

It now seems that all pulmonary hamartomas (PHs) are large cystic-solid lesions that are difficult to diagnose. However, few cases of large cystic-solid PHs have been reported. The present case report presents a large cystic-solid PH and provides a literature review of the imaging features, formation mechanism and histopathological basis of PHs.

CASE SUMMARY

A 53-year-old woman with no clinical symptoms underwent a chest computed tomography (CT) examination at our hospital. Nonenhanced CT images revealed a large, flat tumor with multiple air-containing cysts in the left thoracic cavity and a cystic part confined to the medial side of the tumor; the solid part of the tumor showed abundant fat and lamellar soft tissue components. Multiple small blood vessels were detected in the solid part of the tumor on contrast-enhanced CT images. Given the large size of the lesion, the patient elected to undergo surgery. Histological examination revealed PH. A detailed review of the patient’s CT imaging showed that the lesion had a small vascular pedicle to the left lower lobe, which was a clue to its lung tissue histological origin. According to immunohistochemical staining, the confined multiple air-containing cysts were caused by the entrapment of respiratory/alveolar epithelium.

CONCLUSION

This case shows the imaging manifestations of a large PH. Heightened awareness of its formation mechanism and histopathological basis may alert radiologists to consider this diagnosis in their daily workflow.

Symptomatic Pulmonary Hamartoma

Pulmonary hamartoma is the most common benign tumor of the lungs. It is most often asymptomatic and is discovered incidentally. The condition is two to three times more common in men and is usually seen in the sixth to seventh decade of life. The authors present the case of a 44-year-old female in whom the condition was symptomatic, causing cough, shortness of breath, and fatigue. This case is unusual in that it occurred in a woman in her 40s and was symptomatic. The authors discuss the presentation, clinical features, and management of pulmonary hamartoma.

Características clinicopatológicas de nódulos pulmonares: Experiencia en Clínica Reina Sofía, Bogotá, Colombia

Introducción. El cáncer de pulmón es la primera causa de mortalidad por cáncer a nivel mundial, lo que hace que sea considerado un problema de salud pública. Existen diferentes hallazgos imagenológicos que hacen sospechar la presencia de cáncer de pulmón, uno de los cuales son los nódulos pulmonares; sin embargo, estos también pueden verse en entidades benignas. Métodos. Se incluyeron 66 pacientes con biopsia de nódulo pulmonar en la Clínica Reina Sofía, en la ciudad de Bogotá, D.C., Colombia, entre el 1° de marzo del 2017 y el 28 de febrero del 2020. Se analizaron las características demográficas de los pacientes, las características morfológicas e histopatológicas de los nódulos pulmonares y la correlación entre sus características imagenológicas e histopatológicas. Resultados. El 69,2 % de los nódulos estudiados tenían etiología maligna, de estos el 55,5 % era de origen metástasico y el 44,5 % eran neoplasias primarias de pulmón, con patrón sólido en el 70,6 % de los casos. El patrón histológico más frecuente fue adenocarcinoma. Respecto a las características radiológicas, en su mayoría los nódulos malignos medían de 1 a 2 cm, de morfología lisa y distribución múltiple, localizados en lóbulos superiores. Conclusiones. La caracterización de los nódulos pulmonares brinda información relevante que orienta sobre los diagnósticos más frecuentes en nuestro medio, cuando se estudian nódulos sospechosos encontrados incidentalmente o en el seguimiento de otro tumor. Como el nódulo es la manifestación del cáncer temprano del pulmón, establecer programas de tamización que permitan el diagnóstico oportuno, es hoy día una imperiosa necesidad, para reducir la mortalidad.

Pulmonary Hamartoma Associated With Lung Cancer (PHALC Study): Results of a Multicenter Study

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.

Benign Endobronchial Tumors: A Clinicopathologic Review

Purpose: Benign endobronchial tumors are rare entities that can be difficult to diagnose because they often present with non-specific symptoms and vague radiographic findings. The current study reviews the clinical, radiologic and pathologic features, diagnosis, and treatment of patients with benign endobronchial tumors. Methods: We examined the charts of all patients who presented with biopsy-proven benign endobronchial tumors at a tertiary-care academic medical center between 1993 and 2018. Pertinent clinicopathologic and radiologic data were analyzed, with particular attention paid to treatment modalities and mean overall patient survival. Results: A total of 28 cases were identified. The most common benign neoplasm was hamartoma (37%), followed by lipoma (19%), squamous papilloma (11%), pleomorphic adenoma (7%), mucin gland adenoma (7%), papillary adenoma (3%), hemangioma (3%), neurofibroma (3%), leiomyoma (3%), and papillomatosis (3%). Cough (58%), shortness of breath (44%), and hemoptysis (15%) were the most frequent presentations. Most cases demonstrated well-defined submucosal or pedunculated endobronchial lesions with segmental pneumonia or atelectasis on imaging. Histologic diagnosis was obtained by endobronchial resection in 43% of patients, thoracoscopic lobectomy in 36%, endobronchial biopsy in 18%, and thoracoscopic wedge resections in 3%. All procedures were performed with no intraoperative or in-hospital deaths (mean overall survival: 20.2 years). Conclusion: Benign endobronchial tumors typically present as well-defined submucosal and/or pedunculated lesions, and may lead to post-obstructive complications. Endobronchial resection is the preferred strategy for diagnosis and treatment of these tumors.

Malignant Degeneration of Biopsy-Proven Hamartoma to Chondrosarcoma

Pulmonary hamartomas are benign lesions that are often managed conservatively in the absence of respiratory symptoms. Increasing reports of malignant transformation question if a more aggressive treatment or surveillance practice for these lesions is warranted in adult patients. Herein, we describe a case of a 67-year-old man with a long history of pulmonary hamartoma that demonstrated malignant degeneration into spindle cell malignancy with chondromatous differentiation. This case illustrates the aggressive nature of sarcomatous disease arising from hamartomas and, with a handful of other cases in the literature, points to the question of whether pulmonary hamartomas arising in late adulthood should follow a more intensive treatment or surveillance algorithm given increased concern for malignant potential.

Smooth Muscle Conditions of the Chest: A Clinical, Radiologic, and Pathologic Review

Smooth muscle conditions of the chest have diverse clinical and imaging manifestations and may involve nearly every thoracic structure. Differentiation among these conditions requires the integration of clinical, radiologic, and histopathologic data. Histologic examination in conjunction with immunohistochemistry is essential for differentiation from other spindle cell neoplastic mimics. Familiarity with these entities will ensure the inclusion of smooth muscle conditions in the differential diagnosis of thoracic soft tissue lesions and potentially guide the clinician in appropriate management. We review the clinical, imaging, and histopathologic features of thoracic smooth muscle-related conditions organized by the anatomic structures affected.

Mucinous Adenomyomatous Pulmonary Hamartoma: Clinicopathologic, Immunohistochemical, and Molecular Features of 6 Cases

Pulmonary hamartoma (PH) may show various combinations of mesenchymal tissues with entrapment of respiratory epithelium. An uncommon variant of PH prevalently consisting of smooth muscle with mucinous proliferation has been reported in literature under several definitions as sporadic reports. We collected a series of 6 leiomyomatous PH associated with mucinous growth from consultation files (3 cases) and multicentric revision of archival files among 128 consecutive surgically resected PH. The lesions have a prevalence for male gender (5:1) and lower lobes (5:1), with a mean age at diagnosis of 61 years. All cases were incidentally disclosed in asymptomatic patients and had an indolent behavior. At histology, 2 cases consisted uniquely of smooth muscle and 4 also showed mature adipose tissue. The mucinous proliferation consisted of a monotonous growth of columnar cells lacking p63-positive basal cells and expressing pan-CKs, MUC5A, and CK7, but negative with TTF-1, napsin, MUC1, MUC2, MUC6, CK20, and CDX2. Smooth muscle was negative with hormonal receptors. Molecular analysis using a multiplex gene panel did not reveal gene mutations, while ALK, BRAF, and ROS1 were negative. In conclusion, we describe a small series of uncommon PH with prevalent leiomyomatous mesenchymal component associated with a mucinous growth (mucinous adenomyomatous hamartoma). Despite the lack of basal cells coating mucinous proliferation and irregular architecture, the favorable outcome and lack of molecular alterations most likely lay for a benign/low-grade tumor. Pathologists should be aware of this unusual occurrence to prevent a diagnosis of overt malignancy, particularly in frozen section, small biopsy, and cytology.

Incidental endobronchial hamartoma in a patient with enchondroma

Hamartomas are the most common type of benign tumours of the lung, constituting a small portion of all lung neoplasms. Hamartomas are rare benign tumours composed of multiple mesenchymal cell lines. Two clinical types have been defined according to the location: intraparenchymal and endobronchial, more frequently the former. We present a case of endobronchial hamartoma causing significant blockage of the right middle lobe. The finding was incidental on a CT scan of the chest done for staging purposes for a large mixed lytic and sclerotic lesion that was found within the proximal-mid portion of the tibial diaphysis. The endobronchial lesion was removed by hot electrocautery snare during bronchoscopy and identified as a hamartoma. Argon plasma coagulation was applied to the lesion's base afterwards and the patient was to follow-up in 3 months for a repeat CT scan.

Endobronchial Hamartoma as a Rare Cause of Recurrent Respiratory Symptoms: Case Report and Literature Review

Most of the endobronchial lesions are malignant in origin. In rare instances, benign lesions occupying the endobronchial tree can mimic malignant neoplasms on conventional imaging tests. We present a case of a middle-aged male patient who was admitted to our hospital with recurrent hemoptysis concerning for lung cancer on computed tomography (CT) of the chest. Biopsy of the mass obtained via bronchoscopy revealed a benign lesion most consistent with lipomatous hamartoma, which is known to constitute only 10% of all pulmonary hamartomas. We also present the data of a comprehensive literature review of the epidemiology, clinical symptoms, diagnosis, treatment, and prognosis of patients with endobronchial hamartomas.

Surgical treatment and outcome of pulmonary hamartoma: a retrospective study of 10-year experience

Background

The present retrospective study was designed to review the clinicopathological features and outcome of surgical treatment of pulmonary hamartoma who underwent surgical operation between January 2008 and January 2018.

Methods

The information about the age and gender of patients, symptoms, history of tobacco consumption, the presence of malignancies, radiological and imaging findings, calcification in the hamartoma, location and size of the lesions, findings of preoperative diagnostic investigations, operative procedures, operative time, tube drainage duration, surgical complication, hospital stay after tumor resection, duration of follow-up, and outcome were recorded.

Results

The average size of the neoplasms was 2.72 cm. Five patients (20.8%) had malignancies, which occurred previously in two patients, and concomitantly in three patients. Twenty-four patients underwent surgical treatment which included enucleation in 14 (four cases had thoracoscopic surgery), wedge resection in 8 (six cases had thoracoscopic surgery), and lobectomy in 2 patients. A total of four postoperative complications were noted. The patients were followed up for 2-98 months.

Conclusion

Enucleation was the main choice in our series. The follow-up for a long period revealed no malignant transformation and recurrence. Due to lack of the malignance after operation in our series, we presumed that the enucleation for pulmonary hamartoma was safe enough.

The feasibility of electromagnetic navigational bronchoscopic localization with fluorescence and radiocontrast dyes for video-assisted thoracoscopic surgery resection

Recently, some groups have reported the utilization of electromagnetic navigational bronchoscopy (ENB) for localization of pulmonary lesion. Its application for intraoperative visual localization with dyes to determine the target area has been increasing. In this paper, we reviewed the feasibility of ENB utilization for video-assisted thoracoscopic surgery (VATS) or robotic sublobar resection as a localization tool, and its future application in minimally invasive thoracic surgery.

The frequency of lung cancer in patients with pulmonary hamartomas: An evaluation of clinical, radiological, and pathological features and follow-up data of 96 patients with pulmonary hamartomas

PURPOSE

To investigate the frequency of lung cancer in patients with pulmonary hamartomas and to evaluate clinical, radiological, and pathological characteristics of pulmonary hamartomas.

BASIC PROCEDURES

We reviewed pathology records of pulmonary hamartomas diagnosed between 2003 and 2014. Medical records and the hospital electronic database were also reviewed for each patient to obtain clinical, radiological, and pathological characteristics of pulmonary hamartomas and accompanying malignancies.

MAIN FINDINGS

Ninety-six patients with pulmonary hamartomas were identified. There were 26 females (27%) and 70 males (73%), with a mean age of 56.2 years (range 22-87 years). Malignancies were detected in 23 patients (24%), which developed previously in five patients (1 synchronous, 4 metachronous lesions), and concomitantly in 18 patients (with origin from the lung in 17 patients and from the pleura in 1 patient).

PRINCIPAL CONCLUSIONS

Our results show that patients with pulmonary hamartomas may have coexisting lung malignancies.

Is resection necessary in biopsy-proven asymptomatic pulmonary hamartomas?

A best evidence topic was written according to a structured protocol. The question addressed was: in surgically fit patients with biopsy-proven asymptomatic pulmonary hamartoma, is surgical resection superior to conservative watchful waiting in terms of outcome. A total of 460 papers were identified using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. Three studies were observational following up biopsy-proven asymptomatic pulmonary hamartoma with no resection for a mean period up to 5 years (where mentioned). No patients developed new symptoms or malignant transformation. One of the three studies considered tumour growth in patients with pulmonary hamartoma to be slow with a mean expansion in transverse diameter of 3.2 ± 2.6 mm per year. There were five sizable retrospective studies and one observational study for resection of pulmonary hamartoma. Three of the six studies showed no postoperative mortality but there was an association with major resection (lobectomy/pneumonectomy) ranging from 10 to 14%. There was no tumour recurrence during a long follow-up period in the three studies. One other study had a 4% postoperative mortality rate and a 1.8% postoperative lung cancer developing rate during a follow-up period of 61 months with a consequent recommendation against surgery in asymptomatic patients. In another study, there was a 2.6% recurrence rate after surgical resection during a follow-up period of 7.3 years whereas in the final observational study, 3 patients developed a malignant lung lesion during a follow-up period of 2-10 years after resection and in the same area from where the hamartoma was excised. In conclusion, we would recommend surveillance, rather than resection, of patients with biopsy-proven asymptomatic pulmonary hamartomas, since there is no evidence of malignant transformation during follow-up in any study. Resection is usually safe but a significant number of patients need a major resection (lobectomy or pneumonectomy, 10-14%) for clearance. Diagnosis can be achieved by a combination of radiological evidence and fine needle biopsy (sensitivity 85-90%). Therefore, resection should be reserved for symptomatic patients, or where the diagnosis remains in doubt.

Diffuse vascular hamartoma with malignant behavior

Pulmonary hamartomas are benign lesions, usually asymptomatic and incidentally discovered on a routine chest radiograph; occasionally, however, this benign lesion may cause life threatening symptoms due to it's location and diffuse vascular involvement. We report the case of a 27 year-old male, non-smoker, who presented with dyspnea, cough, hemoptysis and weight loss. He was found to have a mass in the right hilar region which also involved the right main bronchus, pulmonary artery and esophagus. Surgical biopsy of the lesion led to the diagnosis of diffuse vascular hamartoma. Although it was a benign lesion, due to the size and location, surgical removal was not possible and patient died 10 years after being diagnosed with the condition.

Incidence of pulmonary non-epithelial tumors: 18 years' experience at a single institute

Primary and metastatic non-epithelial tumors of the lung and pleura (NETs-LP) are presumed to represent a small proportion of pulmonary neoplasm, and their epidemiologic characterization is lacking. Moreover, classification of pulmonary mesenchymal tumor according to 'WHO Classification of Tumors of Lung and Pleura' (2004) is simple and necessary to give a supplementation like new 'WHO Classification of Tumors of Soft Tissue and Bone' (2013). Non-epithelial tumors of the lung and pleura diagnosed from January 1995 to April 2013 were retrospectively reviewed and classified in accordance with 'WHO Classification of Tumors of Soft Tissue and Bone' (2013). Of 681 cases represented in the study, smooth muscle tumor (13.1%) was most common, and tumor of uncertain differentiation (10.5%) and fibroblastic/myofibroblastic tumor (5.7%) were followed. Smooth muscle tumor (12.6%) was the common primary tumor, whereas chondrogenic or osteogenic tumor (21.6%) was common in metastatic ones. Pulmonary vascular sarcoma (n=15) was the most frequent primary pulmonary sarcoma with following synovial sarcoma (n=9) and malignant type of solitary fibrous tumor (n=9). This study is the first trial of epidemiologic investigation in Korea about NETs-LP, indirectly representing their incidence in Korea and northeast Asia, and we hope that this presentation offers guidance in further study of NETs-LP.

Primary lung and large airway neoplasms in children: current imaging evaluation with multidetector computed tomography

Multidetector computed tomography (MDCT) offers an important noninvasive imaging modality for confirmation and further characterization of primary lung and large airway neoplasms encountered in pediatric patients. Children represent a unique challenge in imaging, not only because of unique patient factors (eg, inability to follow instructions, motion, need for sedation) but because of the technical factors that must be optimized to reduce radiation dose. This article reviews an MDCT imaging algorithm, up-to-date imaging techniques, and clinical applications of MDCT for evaluating benign and malignant primary neoplasms of lung and large airway in infants and children.

Imaging incidental pulmonary nodules

The incidental nodule is an increasingly common clinical conundrum. This article outlines the characteristics that allow differentiation of benign and malignant pathologies and discusses strategies for their follow up and management.

Solitary pulmonary nodule: A diagnostic algorithm in the light of current imaging technique

The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT). The finding of a SPN usually provokes a flurry of clinical and imaging activity as an SPN in at-risk population is an alert signal of possible lung cancer. The frequency of malignant nodules in a given population is variable and depends on the endemicity of granulomatous disease. The percentage of malignant nodules also rises when dealing with at-risk population. The problem is compounded by the fact that with the present generation of CT scanners, 1-2 mm nodules are discovered in approximately half of the smokers aged 50 years or older scanned. A variety of management approaches are applied in the work-up of SPN often requiring evaluation over a long period of time to establish a benign or malignant diagnosis. Comparison with previous imaging studies and morphologic evaluation of the size, margins, and internal characteristics are usually the first step in the evaluation of these nodules. It is often necessary to use additional imaging techniques and occasionally invasive procedures such a percutaneous needle lung or a surgical biopsy. Until recently, the guidelines for follow-up of indeterminate noncalcified nodules detected on nonscreening CT was a minimum of 2 years. However, during the past few years due to further refinements in CT technology and better understanding of tumor behavior, it has prompted a revision of the guidelines of the follow-up of small indeterminate nodules. These guidelines have been endorsed by the Fleischner Society.

The calcified lung nodule: What does it mean?

The aim of this review is to present a pictorial essay emphasizing the various patterns of calcification in pulmonary nodules (PN) to aid diagnosis and to discuss the differential diagnosis and the pathogenesis where it is known. The imaging evaluation of PN is based on clinical history, size, distribution and the gross appearance of the nodule as well as feasibility of obtaining a tissue diagnosis. Imaging is instrumental in the management of PN and one should strive not only to identify small malignant tumors with high survival rates but to spare patients with benign PN from undergoing unnecessary surgery. The review emphasizes how to achieve these goals. One of the most reliable imaging features of a benign lesion is a benign pattern of calcification and periodic follow-up with computed tomography showing no growth for 2 years. Calcification in PN is generally considered as a pointer toward a possible benign disease. However, as we show here, calcification in PN as a criterion to determine benign nature is fallacious and can be misleading. The differential considerations of a calcified lesion include calcified granuloma, hamartoma, carcinoid, osteosarcoma, chondrosarcoma and lung metastases or a primary bronchogenic carcinoma among others. We describe and illustrate different patterns of calcification as seen in PN on imaging.

Pulmonary hamartoma diagnosed by convex probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)

A 71-year-old man with a right hilar mass shadow was referred to our department. Chest computed tomography showed a small fatty area inside. Convex probe endobronchial ultrasound (CP-EBUS) images revealed a heterogeneous low-echoic mass, resembling a stone wall and showing a smooth sliding movement along the tracheal wall during respiration. Transbronchial needle aspiration (EBUS-TBNA) was performed and cartilage cells were identified, compatible with the presence of a hamartoma. The patient requested follow-up without surgical intervention. CP-EBUS images are easier to interpret than other methods for monitoring respiratory dynamics. We conclude that CP-EBUS is a useful addition to techniques both for non-invasive imaging as well as guiding pathological examination.