Fine-needle aspiration cytology of mesenchymal hamartoma of the chest wall

A Rare Case of Hamartoma Chest Wall Following Trauma in a 42-year-old Man

Background:

Chest wall mesenchymal hamartoma (CWH) is a distinct and extremely rare tumor-like lesion of the thorax. It usually presents in the neonatal period or in infancy. The common presentation is in the form of a visible chest wall mass with or without respiratory distress.

Case presentation:

A 42-year-old man with a history of chest wall trauma since 5 years ago was admitted with a swelling of the anterior of the chest wall and during this period has grown slowly. Physical examination showed a left anterior chest wall deformity. Chest radiographs and chest CT showed a left anterolateral chest wall mass involving the fourth and fifth ribs. Thoracotomy was performed. The tumor and involved ribs were resected with a 5cm safe margin. The histopathologic examination showed hamartoma. The patient has been fallowed up since 60 month ago, and has not had any complaints in this time.

Result:

Despite the rarity of chest wall hematoma, this side effect must always be taken into consideration while studying the chest wall injuries especially in the case of trauma history due to other differential diagnosis and her side effects such as respiratory problems.

Conclusion:

Although rare, this condition ought to be kept in mind while dealing with hamartoma Chest wall following trauma in order to avoid its complications such as respiratory problems. Surgical excision is usually curative in combination with conservative therapy if possible.

Aspiration cytology of mesenchymal hamartoma of the chest wall: a case report and literature review

Mesenchymal hamartoma of the chest wall is a rare tumor-like lesion of infancy and childhood. The few available descriptions of the findings on fine needle aspiration list spindle-shaped cells and cartilage or chondromyxoid material as essential features for this diagnosis. An aggressive appearance on imaging studies and a lack of familiarity with this lesion, can lead the pathologist to misdiagnose the cytologic findings as malignancy. We reported a 5-month-old male presenting with a mass of the right chest wall progressively for 2 months. Radiologic studies showed a mixed solid and cystic mass originating from the third, fourth and fifth ribs, and a diagnosis of malignancy was favored. Fine needle aspiration recovered only spindle-shaped cells and a few multinucleated giant cells of osteoclast type. After a review of the imaging, a diagnosis of mesenchymal hamartoma of the chest wall was raised. This diagnosis was confirmed by pathologic examination of the subsequently resected mass. This is the sixth report of a mesenchymal hamartoma of the chest wall diagnosed by fine needle aspiration. This case illustrates that this diagnosis can be suspected in the absence of cartilage or chondromyxoid material, given appropriate clinical and radiologic findings.

Prenatal and postnatal features of mesenchymal hamartoma of the chest wall: case report and literature review

Mesenchymal hamartoma of the chest wall is a rare, benign chondro-osseous tumor of the bone. Although it most commonly presents at birth or soon after, prenatal detection is rare. We report a case of prenatally detected mesenchymal hamartoma, and provide the rationale, details, and outcomes of our management. The literature is reviewed, with particular attention to prenatal detection and postnatal management options.

Mesenchymal hamartoma of the chest wall: prenatal sonographic manifestations

Mesenchymal hamartoma of the chest wall is a rare, benign lesion that arises from one or more ribs, almost exclusively found in infants. Some cases that developed in the fetal period have been reported, but accurate diagnosis was usually possible only after birth, except in a few cases in which fetal magnetic resonance imaging or computed tomography were performed. We present a case of a congenital mesenchymal hamartoma of the chest wall. Although the diagnosis was not confirmed until birth, the prenatal sonographic examination showed strongly suggestive findings. We review the published reports on this condition, and suggest the prenatal sonographic features. Prenatal sonography is valuable in the differential diagnosis of chest mass.

Perinatal evolution of mesenchymal hamartoma of the chest wall

Mesenchymal hamartoma of the chest wall (MHCW) is a rare condition. Previously, surgical resection has been advocated with considerable post-operative morbidity. Evidence for conservative management is lacking because the natural history of MHCW is unknown. We present serial measurements of an antenatally detected MHCW (8 antenatal ultrasounds and 2 postnatal computed tomographic scans). The study demonstrates that the relative tumor size peaked at birth and then decreased postnatally. Based on this evidence, we believe that MHCW can be managed conservatively in an asymptomatic patient.

Unilateral multifocal mesenchymal hamartoma of the chest wall: a case report and review of literature

We report a case of unilateral multifocal mesenchymal hamartoma of the chest wall diagnosed on radiologic imaging, which was proven at surgery and histopathology. To the best of our knowledge, only 3 cases of unilateral multifocal mesenchymal hamartoma of the chest wall have been reported previously in literature in children.

A neonate with respiratory distress and a chest wall deformity

Infants with respiratory distress commonly present to a pediatric emergency department. There are rare but serious conditions that need to be considered in the differential diagnosis. We report the history of an infant that presented to our institution with respiratory distress ultimately diagnosed with a mesenchymal hamartoma of the chest wall. The presentation, diagnosis, and treatment options for mesenchymal hamartoma are discussed.

Multifocal mesenchymal hamartoma of the chest wall

Chest wall hamartomas are extremely rare. Frequently mesenchymal hamartomas are presented as a single mass and contain some primitive mesenchymal elements such as chondroid and trabecular bone structures. A 60-year-old man presented to hospital with chest pain. Thirteen years earlier, his CXR and thoracic CT showed three masses on the right and two masses on the left, but he had not received any treatment thereafter. His CT showed the same masses present 13 years earlier, but they were bigger and right thoracotomy was undertaken. At thoracotomy, two sections of the mass in the right posterior mediastinum and one section of the mass in the right apex were excised. They had an occasional bloody appearance and contained small cystic areas, and some areas were extremely hard. Microscopic examination showed that the lesions consisted of mature adipose tissue, a large number of veins of different diameters and collagen tissue. Besides, primitive mesenchymal elements, lymphoid cell accumulations and trabecular bone structures were seen focally. Bilateral chest wall hamartomas are extremely rare and may be confused with malignancy.

Mesenchymal hamartoma of the chest wall

Mesenchymal hamartoma of the chest wall is an unusual lesion remarkable for its occurrence in early infancy and alarming clinical presentation, which often suggests malignancy. Despite its aggressive appearance and propensity to attain massive size, the lesion behaves biologically in a benign fashion, and may be treated conservatively, provided that there is no respiratory compromise secondary to mass effect. The case of an incompletely resected mesenchymal hamartoma that has behaved in a benign fashion after more than 4 years of follow-up is discussed here. We present this case to provide insight and raise clinicians' awareness of the behavior of an extremely rare tumor.

Mesenchymal hamartoma of the chest wall in infants: report of three cases and literature review

Mesenchymal hamartoma of the chest wall in infants is a rare abnormality. We present a report of three cases and a brief review of the literature, emphasizing the role of the radiologist in diagnosis and management.

Mesenchymal hamartoma of the chest wall: radiologic manifestations with emphasis on cross-sectional imaging and histopathologic comparison

PURPOSE

To describe the imaging features of chest wall mesenchymal hamartoma with emphasis on cross-sectional imaging and comparison with histopathologic results.

MATERIALS AND METHODS

For 14 mesenchymal hamartomas of the chest wall in 12 children, radiologic studies (computed tomographic [CT] scans [n = 14], radiographs [n = 11], magnetic resonance [MR] images [n = 9], and bone scintigraphic images [n = 1]) were reviewed by four radiologists with consensus agreement. Clinical history was reviewed for patient demographics and symptoms at presentation. Radiologic studies were evaluated for lesion location, size, number of affected ribs, cortical irregularity or erosion, presence and type of matrix mineralization, lung hyperaeration adjacent to the lesion, degree and homogeneity of radionuclide uptake, and intrinsic characteristics on CT and MR images.

RESULTS

Patients included seven male and five female children. Nine patients (75%) were younger than 1 year. Five patients had a chest wall mass; in the remaining seven, the lesion was discovered incidentally. All 14 lesions arose from ribs, 11 were located posteriorly, and 11 affected multiple contiguous ribs. Two patients had multifocal disease, each with two discrete lesions. Radiography in all cases revealed a large expansile rib lesion and an associated extrapleural soft-tissue mass, suggesting an aggressive process. Mineralization was seen in seven (64%) lesions at radiography and in 14 (100%) lesions at CT. Hemorrhagic cavities (secondary aneurysmal bone cyst [ABC] regions) were common, seen in nine (64%) lesions at CT and in four (80%) of five lesions imaged with T2-weighted MR imaging.

CONCLUSION

Mesenchymal hamartoma of the chest wall may be recognized by its characteristic occurrence in infancy and cross-sectional imaging features of mineralization and hemorrhagic cystic (secondary ABC) components.