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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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2
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Habib DS, Jani P, Zhao B, Jayaraman EA, Kesavan R. Pulmonary Endobronchial Hamartoma Presenting With Post-obstructive Pneumonia. Cureus 2024; 16:e60916. [PMID: 38910726 PMCID: PMC11193388 DOI: 10.7759/cureus.60916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Pulmonary hamartomas (PH) are rare but are the most common benign tumors found in the lungs. They are slow-growing and are usually found incidentally on chest imaging during the sixth decade of life. Approximately 10% of pulmonary hamartomas are endobronchial. Rarely, pulmonary hamartomas can cause a spectrum of pulmonary symptoms depending on their size and location. We present a case of endobronchial hamartoma causing airway obstruction and recurrent post-obstructive pneumonia.
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Affiliation(s)
- Diane S Habib
- Internal Medicine, Hospital Corporation of America (HCA) Houston Healthcare Kingwood/University of Houston, Kingwood, USA
| | - Pushan Jani
- Internal Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, USA
| | - Bihong Zhao
- Combined Anatomic and Clinical Pathology, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, USA
| | | | - Ramesh Kesavan
- Pulmonary and Critical Care, Hospital Corporation of America (HCA) Houston Healthcare Kingwood/University of Houston College of Medicine, Kingwood, USA
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3
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Özkan M. Pulmonary tumors in childhood. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S73-S77. [PMID: 38584790 PMCID: PMC10995685 DOI: 10.5606/tgkdc.dergisi.2024.25863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 04/09/2024]
Abstract
Pulmonary tumors in childhood are rare, but the majority are malignant. The histopathologic spectrum is quite diverse, including inflammatory myofibroblastic tumor, hamartoma, primary pulmonary paraganglioma, carcinoid tumor, mucoepidermoid carcinoma, pleuropulmonary blastoma, adenocarcinoma, squamous cell carcinoma, and sarcomas. Nonspecific clinical and radiological findings result in late and incorrect diagnoses. Although surgical resection is the initial and proper treatment method, additional adjuvant therapy is dependent on both tumor stage and histopathologic type.
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Affiliation(s)
- Murat Özkan
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Türkiye
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4
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Grigoraş A, Amălinei C, Lovin CS, Grigoraş CC, Pricope DL, Costin CA, Chiseliţă IR, Crişan-Dabija RA. The clinicopathological challenges of symptomatic and incidental pulmonary hamartomas diagnosis. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:607-613. [PMID: 36808195 PMCID: PMC10028331 DOI: 10.47162/rjme.63.4.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Pulmonary hamartomas (PHs) are the most common benign lung tumors. Usually, they are asymptomatic and incidentally discovered during assessment for other diseases or during the autopsy exam. In this context, we have performed a retrospective analysis of surgical resections in a 5-year series of patients diagnosed with PHs in the Clinic of Pulmonary Diseases, Iaşi, Romania, aiming to evaluate their clinicopathological features. A total of 27 patients with PH (40.74% males and 59.26% females) were evaluated. 33.33% of patients were asymptomatic, while the others exhibited variable symptoms, such as chronic cough, dyspnea, chest pain or weight loss. In most cases, PHs presented as solitary nodules, predominantly disposed in the right upper lobe (40.74% of cases), followed by the right lower lobe (33.34%), and left lower lobe (18.51%). The microscopic examination revealed a mixture of mature mesenchymal tissue, such as hyaline cartilage, adipose tissue, fibromyxoid tissue, and smooth muscle bundles, in variable proportions, associated with clefts of entrapped benign epithelium. A dominant adipose tissue component was observed in one case. PH was associated with a history of extrapulmonary cancer diagnosis, in one patient. Although considered benign lung tumors, PHs diagnosis and therapy may be challenging. Having in mind the possibility of recurrence or their occurrence as a part of specific syndromes, PHs should be thoroughly investigated for an appropriate patients' management. Their complex significance and the correlation with other types of lesions, including malignancies, may be further studied, by more extensive studies of surgical and necroptic cases.
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Affiliation(s)
- Adriana Grigoraş
- Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; ; ,
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5
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Guo XW, Jia XD, Ji AD, Zhang DQ, Jia DZ, Zhang Q, Shao Q, Liu Y. Large cystic-solid pulmonary hamartoma: A case report. World J Clin Cases 2022; 10:2650-2656. [PMID: 35434052 PMCID: PMC8968602 DOI: 10.12998/wjcc.v10.i8.2650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/07/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Xiao-Wan Guo
- Department of Radiology, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Xu-Dong Jia
- Departments of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang 050005, Hebei Province, China
| | - A-Dan Ji
- Department of Medical Record Statistics, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Dan-Qing Zhang
- Department of Radiology, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
| | - De-Zhao Jia
- Department of Radiology, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Qi Zhang
- Department of Radiology, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Qiu Shao
- Department of Radiology, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Yang Liu
- Department of Pathology, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
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6
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Giant pulmonary hamartoma with placental transmogrification-a case report. Indian J Thorac Cardiovasc Surg 2021; 37:702-705. [PMID: 34776670 DOI: 10.1007/s12055-021-01207-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022] Open
Abstract
Pulmonary hamartomas are rare tumors and are mostly found incidentally in patients investigated for other pathologies. They are frequently small in size, though with some being reported as large as 25 centimeters (cm). We are reporting a case of a huge pulmonary hamartoma (measuring 25.5 × 17.5 × 15.5 cm and weighing about 2200 grams (g)) in a 33-year-old lady with a short duration history of breathlessness. The tumor had origin from the medial border of the left lung, extending into almost the entire left hemithorax and partly into the anterior mediastinum, with no local invasion. The left lower lobe had compression atelectasis due to mass. The mass was successfully resected. The histopathology report showed predominant adipose tissue and cartilaginous differentiation. There were also a few foci of papillary projections with predominant vascular areas, resembling immature placental villi, suggestive of placental transmogrification of the mass.
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Kumar A, Kumar S, Kushwaha J, Raj V, Mishra A. Unusual Anterior Mediastinal Tumors Treated at a Tertiary Thoracic Center: A Case Series Analysis. Cureus 2021; 13:e17625. [PMID: 34646675 PMCID: PMC8486370 DOI: 10.7759/cureus.17625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
Several tumors arise from different structures within the mediastinum. Although each type of mediastinal tumor has a predilection for a specific compartment, the progression of growth from one compartment to another can occur. The anterior mediastinum is the site of several tumors that pose interesting diagnostic and therapeutic challenges to thoracic surgeons. The anterior mediastinum is the seat of the majority of neoplastic growths within the mediastinum. Thymomas and lymphomas are the most common pathologies of the anterior mediastinum. Tumors of mesenchymal origin (hemangioma, lymphangioma, lipomas) and their malignant counterparts may occur in any of the mediastinal compartments. Less common tumors of the anterior mediastinal compartment are ectopic thyroid and parathyroid tumors, germ cell tumors, mesenchymal origin tumors, hemangiomas, and cervicomediastinal hygromas. Most of the mediastinal growths usually remain clinically silent until they become large and cause compressive symptoms. Here, we present a case series of five anterior mediastinal tumors consisting of solitary benign teratoma, fibrous benign tumor, malignant fibrosarcoma, hamartomatous chondroma, and malignant thymoma.
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Affiliation(s)
- Ambrish Kumar
- Department of Vascular Surgery, King George's Medical University, Lucknow, IND
| | - Shailendra Kumar
- Department of Thoracic Surgery, King George's Medical University, Lucknow, IND
| | - Jitendra Kushwaha
- Department of General Surgery, King George's Medical University, Lucknow, IND
| | - Vaibhav Raj
- Department of General Surgery, King George's Medical University, Lucknow, IND
| | - Archana Mishra
- Department of Thoracic Surgery, King George's Medical University, Lucknow, IND
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8
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Plaksin SA. [Diagnosis and treatment of benign lung tumors]. Khirurgiia (Mosk) 2021:106-111. [PMID: 34029044 DOI: 10.17116/hirurgia2021061106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Benign lung tumors account 2-12% of all lung neoplasms. The classification of lung tumors, adopted by the World Health Organization in 2015, is reported with a detailed indication of all changes based on immunohistochemical and genetic studies. Diagnosis with computed tomography, dynamic and perfusion computed tomography, virtual bronchoscopy and positron emission tomography is described. These methods ensure 94-98% sensitivity for differentiation with malignancies. CT and ultrasound signs of benign tumors are presented. Surgical strategy for newly diagnosed nodes in the lungs is analyzed depending on their dimensions and risk factors. It was shown that comprehensive examination with possible surgical verification of the diagnosis is necessary for nodes over 6 mm and moderate-to-high risk factors. The authors describe argon plasma and laser destruction, bronchoplastic procedures for central benign tumors, thoracoscopy for peripheral neoplasms. One can conclude that high-tech methods of radiological and nuclear diagnosis are valuable to determine benign neoplasms and their dimensions with a high degree of reliability. Endoscopic and thoracoscopic procedures are successfully used for benign tumors.
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Affiliation(s)
- S A Plaksin
- Vagner Perm State Medical University, Perm, Russia
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Abdelghaffar M, Mandeel F, Rabea Z, George S, Al Saeed M. Interlobar Pulmonary Hamartoma With an Unusual Neighboring Lesion: A Case Report. Cureus 2021; 13:e14008. [PMID: 33884249 PMCID: PMC8054229 DOI: 10.7759/cureus.14008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Pulmonary hamartomas are benign lung tumors. They are uncommon and represent a small percentage of all solitary lung lesions. Hamartomas are composed of an abnormal mixture of epithelial and mesenchymal elements. They are usually discovered incidentally as patients are asymptomatic in most cases. On the other hand, sclerosing pneumocytomas are rarely discovered and are one of the most uncommon benign lung tumors. Herein, we present the case of a 37-year-old female who presented with hemoptysis. A computed tomography scan of her thorax revealed a right-sided round lesion in the interlobar fissure with no additional findings. Surgical excision was performed, which demonstrated an uncommon and unique finding of a pulmonary hamartoma coexisting with a sclerosing pneumocytoma found on exploration. This highlights the importance of exploration during surgical procedures in order identify missed lesions on imaging.
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Affiliation(s)
| | - Fatima Mandeel
- Internal Medicine, Salmaniya Medical Complex, Manama, BHR
| | - Zahraa Rabea
- Internal Medicine, Salmaniya Medical Complex, Manama, BHR
| | - Sara George
- Pathology and Laboratory Medicine, Salmaniya Medical Complex, Manama, BHR
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10
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Odak M, AlAzzawi M, Alshami A, Alsaoudi G, Cosentino J. Endobronchial Hamartoma Presenting as Recurrent Pneumonia and Chronic Cough. Cureus 2021; 13:e13717. [PMID: 33833928 PMCID: PMC8019537 DOI: 10.7759/cureus.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Pneumonia is an infection of the lungs that can result from various etiologies, including bronchial obstruction. It is estimated that 5.4% of community-acquired pneumonia occurs as a result of an endobronchial obstruction, classifying them as post-obstructive pneumonia. Pulmonary hamartomas are benign and exceedingly rare tumors. These hamartomas are usually asymptomatic and found incidentally on imaging, however, they can cause patients to develop post-obstructive pneumonia. We present a 40-year-old female with cough, fatigue, and recurrent right lower lobe pneumonia. Upon workup with bronchoscopy and biopsy, she was subsequently found to have an endobronchial hamartoma resulting in recurrent pneumonia in the same location. We are happy to report that the patient had a resection of the mass, as well as of the affected lung lobe, and has been pneumonia-free for five months. We hope to encourage a greater index of suspicion for endobronchial masses, including rare tumors, when a patient presents with recurrent pneumonia in the same location.
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Affiliation(s)
- Mihir Odak
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Mohammed AlAzzawi
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Abbas Alshami
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Ghadier Alsaoudi
- Pulmonary and Critical Care Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - James Cosentino
- Pulmonary and Critical Care, Jersey Shore University Medical Center, Neptune, USA
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11
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Wu L, Chen W, Li P, Li S, Chen Z. Case Report: Resection of Giant Endotracheal Hamartoma by Electrosurgical Snaring via Fiberoptic Bronchoscopy in a 9-Year-Old Boy. Front Pediatr 2021; 9:528966. [PMID: 33987147 PMCID: PMC8111287 DOI: 10.3389/fped.2021.528966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Endotracheal hamartomas are rarely encountered in children. The symptoms of endotracheal hamartoma may include cough, dyspnea, hemoptysis, chest pain, purulent sputum, and fever. The non-specific symptoms often result in a delayed diagnosis. Among the various treatments of this rare disease, surgical resection seems to be the most widely used, while endoscopic treatment is rarely described. Herein, we describe the case of a 9-year-old boy with an endotracheal hamartoma that was successfully excised by electrosurgical snaring via fiberoptic bronchoscopy (FB). The resection of select benign endotracheal tumors in children can be conducted using electrocautery, which can be regarded as an alternative therapy to bronchotomy.
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Affiliation(s)
- Lei Wu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wei Chen
- Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - PengCheng Li
- Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Shuxian Li
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhimin Chen
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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12
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Khari P, Mullick S, Chauhan D. Solitary pulmonary nodule − Pulmonary hamartoma. THE JOURNAL OF ASSOCIATION OF CHEST PHYSICIANS 2020. [DOI: 10.4103/jacp.jacp_11_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Geramizadeh B, Mottavvas M, Zeyaian B, Amirian A. Giant hamartoma of lung presented with massive hemoptysis: A rare case report and review of the literature. Rare Tumors 2019; 11:2036361318823926. [PMID: 30719262 PMCID: PMC6348499 DOI: 10.1177/2036361318823926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/06/2018] [Indexed: 12/28/2022] Open
Abstract
Hamartoma of lung is a common tumor, majority of which are small and incidentally discovered during plain chest radiography. Our case is a 30-year-old gentleman with an extremely uncommon presentation of a common tumor, that is, a giant hamartoma of lung presenting as massive hemoptysis and intractable cough. To the best of our knowledge, such occurrence of giant pulmonary hamartoma is very uncommon and its presentation with massive hemoptysis is even more uncommon. Less than 20 cases of giant hamartoma of lung have been reported in the English literature so far.
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran.,Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maedeh Mottavvas
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bijan Zeyaian
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Amirian
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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