A 63-year-old man with a chronic cough and an endobronchial lesion. Diagnosis: Endobronchial hamartoma

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.

Severe Central Airway Obstruction Secondary to a Giant Endobronchial Hamartoma: A Case Report

Central airway obstruction refers to the occlusion of more than 50% of the trachea, main stem bronchi, or lobar bronchus. It can potentially become a life-threatening condition. Pulmonary hamartomas (PH) are rare tumors with an incidence of 0.25%, constituting about 8% of all benign lung neoplasms. Only 10% of PH occur endobronchially, while the remaining appear peripherally. We present the case of a women with an endobronchial hamartoma that required emergent resection by bronchoscopy. This is 44-year-old woman, with a history of an endobronchial mass on the right main stem bronchus (RMSB) without histopathological diagnosis or surgical management. She presented with a history of chronic cough and expectoration. Upon admission, a chest X-ray was performed, showing opacities of the right lung and amputations of the RMSB. Bronchoscopy was performed and a tumor-like mass that occludes the RMSB was found, with valve effect causing intermittent occlusion. In anesthetic induction, she presents severe airway obstruction and cardiorespiratory arrest. During resuscitation maneuvers, the lesion that was obstructing the light is seen and resection was performed with electrocautery and cryotherapy probes. Histopathological report described an endobronchial chondromesenchymal hamartoma, with no signs of malignancy. The control X-ray showed adequate re-expansion of the right lung. In conclusion, although endobronchial hamartoma has a low incidence and has a slow growth rate, it can manifest as severe airway obstruction. To achieve a complete resection of an endobronchial lesion, both rigid and/or flexible bronchoscopy plus multimodal interventions are recommended.

Two-stage S7 sleeve resection of the right lower lobe and S1+2 and S3 segmentectomy of the left upper lobe: a case report

Synchronous multiple nodules in the lungs, such as peripheral ground-glass opacities (GGOs) and solid small nodules, are common, but only lesions suspected of being malignant should be surgically removed. The surgical strategy is anatomical sub-lobectomy in early stage of non-small cell lung cancer synchronously or asynchronously to decrease the impact of lung resection on the lung function. Here, we report a case of a 56-year-old man, who was a pack-a-day smoker, with endobronchial hamartomas the medial basal bronchus (B7). The patient underwent sleeve resection of the medial basal segment in the right lower lobe, followed by S¹⁺² and S³ segmentectomy because of early-stage lung adenocarcinoma (T1a), which presented as mixed GGOs located in the left upper lobe. The performance of S⁷ sleeve segmentectomy of the RLL is very rare. The main concern is stenosis of the anastomosis and the major technical striking point is the caliber discrepancy between proximal and distal bronchi. In our experiences, we used high-tech methods as three-dimensional reconstruction to provide a basis for our surgical planning and proper patient selection and a series of preventing measures taken for anastomotic stenosis, successfully avoided complications. This case provides a new strategy for the treatment of patient with multiple early-stage lung cancer and benign endobronchial tumors, simultaneously.

Endobronchial hamartoma mimicking malignant lung tumor contralateral endobronchial metastasis: A case report

RATIONALE

Endobronchial hamartoma, the most common benign lung tumor, is located in the bronchus, and it easily mimics lung cancer or bronchial metastasis. Endobronchial hamartoma can cause coughing, hemoptysis, and pulmonary infection; thus, it should be treated right away by surgery or fiberoptic bronchoscopy.

PATIENT CONCERNS

We report a rare case of endobronchial hamartoma in which the clinical symptoms and imaging overlapped strongly with malignant lung tumor contralateral endobronchial metastasis.

DIAGNOSES

Endobronchial hamartoma coexisting with a malignant lung tumor.

INTERVENTIONS

Fiberoptic bronchoscopy was conducted, and the pathologic diagnosis was hamartoma. A second fiberoptic bronchoscopy was conducted, and fine-needle aspiration cytology of the enlarged lymph nodes indicated squamous cell carcinoma.

OUTCOMES

The clinical symptoms were relieved, and the treatment options were docetaxel, cis-dichlorodiamineplatinum, and endostatin.

LESSONS

Fiberoptic bronchoscopy needs to be guided by imaging and can be considered an effective method for the diagnosis of endobronchial hamartoma.

Endobronchial hamartoma: a rare disease with more common presentation

Hamartomas are the most common benign tumours of the lung with an overall incidence of 0.025-0.32%. They are known to be amalgamation of various tissue types, originating from the embryonic mesoderm. Lung hamartomas typically involve lung parenchyma and only infrequently grows as endobronchial tumours. We present a case of an 80-year-old man who presented to the pulmonary clinic for consultation for breathlessness, recurrent pneumonias and an abnormal radiograph finding. CT scan of the chest showed scattered infiltrates and atelectasis in the left upper lobe. He underwent a diagnostic bronchoscopy that showed a lobulated endobronchial lesion obstructing the left upper lobe bronchus. Brush and forceps biopsies were obtained that were consistent with an endobronchial hamartoma. He was referred to the pulmonology department for endobronchial debulking of the lesion following which he improved clinically during postoperative follow-up.

Endobronchial Hamartoma Subtotally Occluding the Right Main Bronchus and Mimicking Bronchial Carcinoid Tumor

Hamartomas are very rarely identified as an endobronchial lesion. Herein, we describe a peculiar case of a 55-year-old woman with persistent cough and increasing dyspnea and radiological detection of a solid lesion subtotally occluding the main right bronchus. Despite the radiological and radiometabolic (18-fluoro-2-deoxy-d-glucose positron emission tomography/computer tomography scan) features were highly suspected for bronchial carcinoid, the definitive diagnosis after endoscopic removal was indicative of an endobronchial hamartoma. When considering differential diagnosis of an endobronchial lesion, the physicians should take firmly in mind such rare entity and, accordingly, bronchoscopy and bronchoscopic biopsy should be done as first step in management of all cases presenting with endobronchial lesions.

Outcome of incidentally detected airway nodules

Low-dose chest computed tomography (LDCT) screening increased detection of airway nodules. Most nodules appear to be secretions, but pathological lesions may show similar findings. The National Comprehensive Cancer Network (NCCN) recommends repeating LDCT after 1 month and proceeding to bronchoscopy if the nodules persist. However, no reports exist about incidentally detected airway nodules. We investigated the significance of airway nodules detected by LDCT screening.We screened patients with incidental airway nodules detected by LDCT in the Seoul National University Hospital group. The characteristics of computed tomography, bronchoscopy, pathology and clinical findings were analysed.Among 53 036 individuals who underwent LDCT screening, 313 (0.6%) had airway nodules. Of these, 186 (59.4%) were followed-up with chest computed tomography and/or bronchoscopy. Seven (3.8%) cases had significant lesions, including leiomyoma (n=2), endobronchial tuberculosis (n=2), chronic inflammation (n=1), hamartoma (n=1) and benign granuloma (n=1). The remaining 179 lesions were transient, suggesting that they were secretions.The use of LDCT for lung cancer screening demonstrated the low incidence of airway lesions. Most lesions were transient secretions. True pathological lesions were rare, and no malignant lesion was found. The current recommendation of the NCCN guideline is a reasonable approach that can avoid unnecessary bronchoscopy.

Endobronchial hamartoma as a cause of pneumonia

Patient: Male, 66

Final Diagnosis: Endobronchial hamartoma

Symptoms: Fever

Medication: —

Clinical Procedure: Flexible bronchoscopy • surgical resection

Specialty: Pulmonology