Cystic pulmonary hamartoma

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.

Giant cystic pulmonary hamartoma-images

Hamartoma is the commonest benign tumor of the lung. They usually present as an asymptomatic solitary solid nodule of varying size, located peripherally in the lung parenchyma and picked up incidentally in a chest X-ray. Rarely, they may be intra-bronchial in location. A giant cystic variant of hamartoma is very rare, with only a few cases reported in literature so far. It may be misdiagnosed as any other cystic disease of the lung and thus get mismanaged. We herewith present the images of a patient with a giant cystic pulmonary hamartoma who presented with respiratory distress.

Abundant cartilage formation of congenital pulmonary airway malformation--a case report

Congenital pulmonary airway malformation (CPAM) of the lung is an uncommon developmental anomaly. We report an unusual case of type 1 CPAM with abundant cartilage in a 5-year-old boy. On chest radiography, a left lung mass was detected incidentally, and tumor resection was performed under the impression of a benign tumor. The pathological examination of the mass revealed abundant cartilage in the walls of malformed bronchioles with partially cystic dilatation. We think that this case represents a cartilaginous variant of CPAM. The cartilaginous variant of CPAM should be differentiated pathologically from other pulmonary neoplasms containing abundant cartilage, such as chondroid hamartoma.

Giant cystic chondroid hamartoma

We report a case of huge pulmonary chondroid hamartoma with multilocular cysts in a 38-yr-old male patient. The lobectomy specimen of the left lower lobe showed a large multilocular cystic mass, 11.5 x 10 cm in size. The mass had thin-walled, variable-sized cysts and areas of solid cartilaginous small nodules in the interstitium, which occupied the superior segment and the upper portion of the basal segment. There was no connection with bronchus or vessel. Microscopically, the cysts and cleft-like spaces were lined by ciliated columnar epithelium and the solid components were composed of cartilage, myxohyalinized connective tissue, and adipose tissue. Also seen were foci of calcification within the sclerotic stroma.

Atypical lipomatous tumour (lipoma-like well-differentiated liposarcoma) arising in a pulmonary hamartoma and clinically presenting with pneumothorax

We document an uncommon variant of pulmonary hamartoma (PH), discovered in the left upper lobe of a 60-year-old man after an episode of pneumothorax, a unique clinical presentation for such an occurrence. The tumour showed a prominent leaf-like pattern and was mainly composed of mature fat with adipocytes of different size and scattered throughout lipoblasts and floret-like cells. A lobectomy was performed and more than 7 years after surgery the patient's course is still uneventful. This case represents an exceedingly rare example of an histologically malignant change in PH and bears a close clinicopathologic resemblance to atypical lipomatous tumours of soft tissues.

Giant hamartoma of the lung

In the following case of giant pulmonary hamartoma, a 62-year-old woman exhibited a huge tumor shadow in the right lung field, whilst remaining asymptomatic. A thoracotomy revealed a solid intrapulmonary mass histologically diagnosed as a cartilaginous hamartoma with no evidence of malignancy. The tumor was resected by enucleation and there has been no recurrence for 40 months since surgery. Parenchyma-saving enucleation or excision is a safe and sufficient procedure for peripheral hamartomas of any size.