Pulmonary hamartoma

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.

Unusual Anterior Mediastinal Tumors Treated at a Tertiary Thoracic Center: A Case Series Analysis

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.

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 tumours of the bronchopulmonary system

The vast majority of tumours arising in the bronchopulmonary system are malignant in nature. Benign tumours of the lung are relatively rare and are often incidental findings during clinical investigations for unrelated conditions. These lesions can arise in the bronchial tree or the pulmonary parenchyma and may be of epithelial, mesenchymal, salivary gland-type or unknown differentiation. Although the spectrum of these lesions is wide, the clinical, pathological and immunohistochemical characteristics of the most relevant will be the subject of this review. In addition, the most important features allowing differentiation from malignant pulmonary neoplasms will be discussed.

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.

The Usefulness of Imaging Quantification in Discriminating Non-Calcified Pulmonary Hamartoma From Adenocarcinoma

Background

Patients with non-calcified hamartoma were more susceptible to surgery or needle biopsy for the tough discrimination from lung adenocarcinoma. Radiomics have the ability to quantify the lesion features and potentially improve disease diagnosis. Thus, this study aimed to discriminate non-calcified hamartoma from adenocarcinoma by employing imaging quantification and machine learning.

Methods

Forty-two patients with non-calcified hamartoma and 49 patients with adenocarcinoma were retrospentation; Manual lesion segmentation, feature quantification (e.g., texture features), and artificial neural network were performed consecutively. Independent t-test was used to conduct the inter-group comparisons of those imaging features. Receiver operating characteristic curve was performed to investigate the discriminating efficacy.

Results

Significantly higher contrast, cluster prominence, cluster shade, dissimilarity, energy, and entropy in non-calcified hamartoma were observed compared with lung adenocarcinoma. Texture-grey-level co-occurrence matrix showed a well discrimination between non-calcified hamartoma and adenocarcinoma as the detection sensitivity, specificity, accuracy, and the area under the curve were 87.22% ± 9.07%, 82.64% ± 8.07%, 85.11% ± 5.40%, and 0.942, respectively.

Conclusion

Quantifying imaging features is a potentially useful tool for clinical diagnosis. This study demonstrated that non-calcified hamartoma has a heterogeneous distribution of attenuations probably resulting from its complex organizations. Based on this property, imaging quantification could improve discrimination of non-calcified hamartoma from adenocarcinoma.

[Mimics of lung cancer]

Lung cancer is a histologically, immunologically and therefore morphologically and functionally very heterogeneous group of neoplasms with the highest cancer mortality worldwide. Therefore, the range of diseases mimicking lung cancer is also very broad and includes congenital, infectious and inflammatory changes as well as other benign space-occupying lesions and other primary and secondary pulmonary neoplasms. The difficulty in radiology lies in the ability to diagnose lung cancer with a high degree of certainty. This must take the limits of the specific diagnosis, knowledge of the classical pitfalls and rare entities that can imitate lung cancer into consideration. Narrowing the differential diagnosis requires close interdisciplinary cooperation and consideration of the patient's clinical and medical history. An accurate analysis of the computed tomography (CT) pattern and distribution of the lesions as well as consideration of additional changes and involvement of other organ systems can be the key to the diagnosis. The use of fluorodeoxyglucose positron-emission tomography CT (FDG-PET-CT) is helpful only in a few mimics of lung cancer. The article describes clinical and radiological findings of mimics of lung cancer also pointing out the limitations of CT and PET-CT for the diagnosis.

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.

Variable alterations of mitochondrial microsatellite instability and DNA copy number in pulmonary hamartomas

BACKGROUND

The genetic alteration of mitochondrial DNA has been regarded as an important step in the development of several human tumors.

OBJECTIVE

The purpose of this study was to identify frequency of mitochondrial microsatellite instability (mtMSI) and alterations in mitochondrial DNA copy number (mtCN) in pulmonary hamartoma.

METHODS

DNA was isolated from tumor tissue and matched non-tumor tissue in 30 patients with pulmonary hamartoma. BAT 25 and 26 were used as nucleus MSI (nMSI) markers, and (C)n and (CA)n in D-loop were used as mtMSI markers. MtCNs were quantified using a competitive quantitative real-time polymerase chain reaction.

RESULTS

nMSI was detected in 5 patients (23.8%) and mtMSI was detected in 2 patients (9.5%) of total 21 hamartoma. There were 14 patients (46.7%), 2 patients (6.7%), and a further 14 patients (46.7%) in the decreased, no change, and increased mtCN groups, respectively. The mean relative mtCN were 0.4 ± 0.3 in the decreased and 3.9 ± 5.1 in the increased mtCN groups, respectively.

CONCLUSIONS

nMSI was more frequently appeared than mtMSI in hamartomas, and we also found measurements of mtCNs in patients with pulmonary hamartoma to be extremely variable without any characteristic pattern.

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.

Pulmonary chondromatous hamartoma with pleural dissemination: report of a case

We herein describe a very rare case of pulmonary hamartoma with pleural dissemination. A 77-year-old male was referred to our department for a further investigation of an abnormal chest radiograph. Chest computed tomography showed a 15 mm nodule in the left lung with small pleural nodules. Thoracoscopic resection of the nodules was performed, as the possibility of malignancy could not be ruled out. The intraoperative findings revealed a white nodule with a lumpy surface in the left lower lobe that had penetrated the visceral pleura. Several smaller nodules were found on the pleural surface. Pathologically, the pulmonary and pleural nodules were chondromatous hamartomas.

Pulmonary hamartoma resembling multiple metastases: A case report

The current study presents the case of a patient with multiple pulmonary nodules as observed by computed tomography. Furthermore, a marginal increase in fluorodeoxyglucose uptake was identified by positron emission tomography. Due to the appearance of multiple small nodules and a history of radical nephrectomy, a hypothetical diagnosis of pulmonary metastasis of a previously excised renal carcinoma was determined, which was confirmed by biopsy. Video-assisted thoracoscopic surgical resection of the nodules was proposed and pathological examination exhibited an unforeseen and rare observation.

A case of pulmonary hamartoma showing rapid growth

A 65-year-old man was admitted for detailed examination of a growing nodular shadow in the left lung. The nodular shadow was initially detected in a routine chest X-ray check-up in March 2012 that warranted regular chest X-ray follow-up. The nodular shadow increased in size from 12 × 15 mm to 15 × 20 mm within five months. The calculated tumor doubling time (TDT) in our case was approximately 132.2 days. A malignant tumor was strongly suspected based on the rapid growth, and tumorectomy was thus performed. Cartilaginous tissue accounted for most of the pathological specimen, but a small amount of an epithelial component was observed histologically, and we diagnosed a hamartoma. Hamartoma generally shows slow annual growth, but it is important to recognize that rapid enlargement occurs in some cases.

Endobronchial hamartoma

Pulmonary hamartoma is a benign lung neoplasm and it comprises 6% of solitary pulmonary nodules. Two clinical types have been defined according to its location: intraparenchymal (90%) and endobronchial (10%). We report on a case of endobronchial hamartoma resected with electrocautery by a flexible bronchoscope (FB). A 57-year-old male patient was admitted to our clinic because of worsening dyspnea. The patient had been smoking 1 pack per day for 37 years. A solid smooth lesion with calcification, located in the distal part of the left main bronchus and partially obstructing the lumen of bronchus, was detected at computerized tomography. A mass lesion that moved with coughing was observed during FB. The polypoid mass was arising from the anterior wall of the left main bronchus. Punch biopsies were taken from the polypoid lesion and a diagnosis of bronchial papilloma was made after histopathologic examination. The patient underwent endobronchial electrosurgery and the lesion was excised using FB. Pathologic evaluation revealed it to be a cartilagenous hamartoma. In conclusion, endobronchial hamartomas are benign neoplasms of the tracheobronchial tree. Endoscopic treatment with flexible bronchoscopic electrocautery is safe and less invasive in experienced hands. Therefore, it should be considered as the primary treatment approach in selected cases.

Endobronchial hamartoma causing massive hemoptysis

Endobronchial hamartoma is an unusual clinical entity and infrequently causes hemoptysis. This brief report extends the sparse available experience with endobronchial hamartoma causing hemoptysis by presenting, to our knowledge, only the third such patient reported to have massive hemoptysis complicating an endobronchial hamartoma.

[Giant hamartoma of the lung]

Hamartomas are the most common benign tumors of the lungs and usually present as solitary intraparenchymal lesions a few centimeters in diameter which are detected radiologically as an incidental finding. This article reports on a case of a giant pulmonary hamartochondroma 29 cm in diameter, which impressed preoperatively and intraoperatively as an extrapulmonary neoplasm. The detection of smaller mesenchymal neoplastic lesions in the lungs and pleura is a further special feature of this case.

Endobronchial lipomatous hamartoma with mediastinal extension

Endobronchial hamartoma is a special form of pulmonary hamartoma. We report a histologically proven case of an endobronchial lipomatous hamartoma with extrabronchial-mediastinal extension in a 64-year-old patient, and we describe the computed tomography and magnetic resonance imaging findings. To our knowledge, this is the first reported case of an endobronchial hamartoma extending into the mediastinum.

Predominant cartilaginous hamartoma: an unusual variant of chondromatous hamartoma

Chondromatous hamartomas are the most common benign lung tumors and the third most common pulmonary nodule. Histologically, they are characteristically composed of hyaline cartilage mixed with fibromyxoid stroma and adipose tissue surrounded by epithelial cells. We report the case of a healthy, 60-year-old woman with an incidentally discovered chondromatous hamartoma that was thorascopically excised. Her pulmonary hamartoma was predominantly cartilaginous, which only occurs in 1% of hamartomas.

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.

Diagnostic efficacy and characteristic feature of MRI in pulmonary hamartoma: comparison with CT, specimen MRI, and pathology

OBJECTIVES

To determine the diagnostic efficacy of magnetic resonance imaging (MRI) in pulmonary hamartoma and observe the significant MRI features, other than fat or characteristic calcification revealed by computed tomography (CT).

METHODS

Six hamartomas were included and surgically resected, and we prospectively studied MRI in cases showing suggestive findings of hamartoma or indeterminate nodule on CT. We analyzed the tumor on CT and MRI (available enhancement study in 4) focusing on cleftlike structure in comparison with specimen MRI (n = 3) and histopathologic findings: presence, shape, and distribution of the cleftlike structure and signal intensity and enhancement of the cleftlike structure and main portion.

RESULTS

Computed tomography revealed suggestive findings of pulmonary hamartoma (fat or popcorn calcification) in only 3. All MRI revealed cleftlike structures particularly evident on T2-weighted images with same detectability as its specimen MRI: peripheral linear or curvilinear inclusions with sometimes intratumoral cleftlike space (n = 3), variable signal intensity, and frequent enhancement (3 in 4) pathologically correlated with the variable mesenchymal tissue components and amount arrayed along respiratory epithelial cells lining the cleft and richer vascularity than main portion of pulmonary hamartoma.

CONCLUSIONS

Magnetic resonance imaging study is a useful diagnostic tool, when a discrete pulmonary nodule demonstrates neither fat nor calcification on CT, for detecting the quite typical cleftlike structure in a pulmonary hamartoma and could provide diagnostic confidence.

Giant pulmonary hamartoma

A 61-year-old woman presented with dyspnea and intense cough. Chest radiography showed opacity of the entire left hemithorax and computed tomography of the chest confirmed a solid heterogeneous mass extending from apex to base, with foci of calcification and areas of low attenuation. Left upper lobe resection was performed, removing the tumor in large pieces. Histologic characteristics of the lesion were compatible with typical hamartoma. No signs of recurrence were detected 2.5 years after the operation.

Giant cystic chondroid hamartoma of the lung

Pulmonary hamartoma composed of an abnormal mixture of mesenchymal elements is the most common benign neoplasm in the lung. Pulmonary hamartoma larger than 10 cm and the cystic variant are also very rare. We describe an asymptomatic 11-year-old boy with a huge mass in the right hemithorax. Chest computed tomography revealed a heterogeneous mass filling the middle and the lower lobes of the right lung. The patient underwent thoracotomy and resection of the lesion. Gross examination of the surgical specimen showed a well-circumscribed, encapsulated, lobulated, and bluish-white mass, measuring 18 x 16 x 8 cm. Multilocular cystic spaces with intervening lobulated fragments of cartilaginous tissue and adipose tissue were seen. Microscopically, the solid component was composed of cartilage and adipose tissue. Cystic areas and cleft-like spaces were lined by ciliated columnar epithelium. We believe this is the first case of 'giant cystic chondroid hamartoma of the lung' described in childhood. We suggest that giant cystic pulmonary hamartoma should be included in the differential diagnosis of large intrathoracic masses in children.

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

BACKGROUND

Controversy still exists in the indication and timing of surgical treatment of pulmonary hamartoma (PH). The objective of this study is to summarize the experience and the outcome of the surgical treatment for pulmonary hamartomas, and to assess the effectiveness and necessity of surgical therapy administered in patients with pulmonary hamartoma as well as clinical and pathological features and long-term follow-up results.

METHODS

This retrospective report has reviewed a 20-years clinical history of surgical treatment for 39 patients with PH from 1985 to 2006. These thirty-nine patients underwent 40 operations as follows: wedge resection (23), enucleation (10), segmentectomy (3), lobectomy (3), and pneumonectomy (1).

RESULTS

The PH occurred most frequently (78.1%) in the patients aged 40 to 60 years and the sex ratio (male/female) was 2.25/1 in our series. No postoperative death was encountered. One patient with pleural effusion was cured after thoracentesis. All of these 39 patients were proved with pathologic diagnosis of PH and the popcorn calcification was found in 6 cases before operation. In 38 cases having the mean follow-up of 7.3 years, a patient was operated thrice for regional recurrence.

CONCLUSION

Fast frozen section in operation is critical for acquire accurate pathological diagnosis. Due to potential trend of recurrence or malignancy, patients with hamartoma should be submitted to a complete evaluation and a regular follow-up.

Pediatric pulmonary tumors: primary and metastatic

Pediatric pulmonary tumors are rare. There is often a significant delay in diagnosis of pulmonary tumors secondary to their rarity and nonspecific presenting physiologic and radiographic findings. A high index of suspicion in pediatric patients with recurrent or persistent pulmonary symptoms is of paramount importance in diagnosing pulmonary tumors at an early stage. Malignant pulmonary tumors are more frequently diagnosed than benign lesions, with metastatic cancers being the most common. Complete surgical resection remains the basis of therapy for primary lesions, and its role in secondary cancers is becoming more established. Adjuvant therapies are frequently employed depending on the precise tumor involved. Mortality rates vary greatly depending on tumor location, stage, and type.

Hamartoma pulmonar como diagnóstico diferencial de metástase de carcinoma de mama: relato de caso

Relata-se o caso de uma paciente de 60 anos, em menopausa há 14 anos, com presença de nódulo pulmonar à radiografia de tórax diagnosticado no seguimento pós-operatório por neoplasia de mama. A paciente tinha história de mastectomia e linfadenectomia axilar ipsilateral por carcinoma ductal invasivo de mama, assim como de hormonioterapia, quimioterapia e radioterapia adjuvante. Após nodulectomia por vídeotoracoscopia, o exame de congelação mostrou tratar-se de um hamartoma pulmonar. Estudos recentes demonstram que 75% dos pacientes que se submeteram a cirurgia por nódulos pulmonares após mastectomia curativa de câncer de mama apresentaram metástases pulmonares, 11,5% apresentaram câncer primário de pulmão e 13,5% apresentaram lesões benignas, dentre as quais o hamartoma.

Endobronchial lipomatous hamartoma: an unusual cause of bronchial obstruction (2007: 7b)

Imaging findings were reported in an unusual case of endobronchial lipomatous hamartoma obstructing the left mainstem bronchus. Computed tomography readily demonstrated the presence of fat density within the lesion narrowing the differential diagnosis to endobronchial lipoma or lipomatous hamartoma.

Giant Pulmonary Hamartoma—A Rare Presentation of a Common Tumor

Hamartomata, the most common benign tumors of the lung, are rarely symptomatic and usually come to clinical attention as coin-shaped lesions on a routine plain chest roentgenogram. We report a case of a 63-year-old woman presenting with reduced endurance on exercise. The plain chest roentgenogram showed a tumor in the left chest. After clinical work-up, the patient underwent radical tumor resection through a lateral thoracotomy. The resected tumor, with two separate nodules, measured 26 x 25 cm and weighed 3.2 kg. The histopathology work-up showed pulmonary hamartoma.

Rapidly growing endobronchial hamartoma with bone marrow tissue

A 29-year-old woman presented with a 4 x 3.5 cm circumscribed mass located in the left upper lobe, which had not been detected in a chest roentgenogram that was taken 3 years prior. Bone scintigraphy using technetium-99m methylene diphosphonate revealed an increased uptake of the isotope in the mass, indicating increased osteoplastic activity. She underwent surgical resection of the mass and the pathologic diagnosis was endobronchially located pulmonary hamartoma, which contained bone marrow tissue. An extremely rare case of pulmonary hamartoma showing rapid growth and involving bone marrow tissue is presented.

Lung osteoma--a new benign lung lesion

Extraskeletal osteomas have not been described in the lung. Tumors with osseous elements can be found, such as hamartoma and amyloid tumor, and reactive lesions such as osseous metaplasia. A 39-year-old male patient was treated for multiple myeloma and got a bone marrow transplantation 2 years and a few months before he presented with a solitary well-circumscribed tumor in the right middle lobe. The patient underwent surgical resection. The tumor presented with a fibrous capsule and consisted of mature bone trabecules. Within the tumor, fatty tissue was seen. There were small bone spicules interpreted as areas of new bone formation and appositional growth. No amyloid deposition, no immature epithelial tubules as in hamartomas, and no normal lung structure as in osseous metaplasia were seen. Within the osseous elements, a positive reaction was seen with antibodies for osteonectin, whereas the reaction for calcitonin was negative. To the best of our knowledge, this is the first case of an osteoma being reported in the lung looking like any other extraskeletal osteoma. This tumor might have been induced by circulating stem cells; however, due to autologous bona marrow transplantation, this cannot be proven.

Lung Nodule Detection and Characterization With Multi-Slice CT

The influence of MSCT on nodule detection and characterization will be discussed. The objective is to improve understanding of the clinical issues involved in nodule detection, characterization, and management in light of technological advances. Topics to be covered are noninvasive characterization techniques, such as morphologic and density inspection on CT, nodule enhancement techniques, CT-PET, temporal nodule size assessment, and computer aided diagnosis for both detection and characterization.

Hamartochondrome pulmonaire : une cause rare de nodule pulmonaire solitaire en pédiatrie

Solitary pulmonary nodules are rare in children. We report an eleven year-old girl evaluated for recurrent respiratory symptoms diagnosed with an intraparenchymal pulmonary hamartochondroma. Spiral computed tomography showed a pulmonary nodule in the middle lobe, 17 mm in diameter, without any specific features. In asymptomatic adult patients, guidelines for the management of solitary pulmonary nodules have been described. The management of solitary pulmonary nodules in pediatric patients is discussed.

Chromosomal aberrations, profiles of expression of growth-related markers including galectins and environmental hazards in relation to the incidence of chondroid pulmonary hamartomas

This prospective study includes 103 cases of chondroid pulmonary hamartomas, resected over a period of nearly six years. Genes encoding proteins of the high motility group (HMGI-C, (Y), chromosomes 12q15 and 6p21) were analyzed cytogenetically. Furthermore, we examined the expression of growth-regulatory markers, including galectins-1, -3, -8, heparin-binding lectin (HBL), calcyclin (S100A6) and macrophage migration inhibitory factor (MIF), as well as that of Ki-67 (MIB-1). Syntactic structure analysis was applied to automated classification of stained histological slides and for the detection of topological properties in hamartomas and disease-free lung. These data were set in relation to clinical features, including environmental hazards, smoking habit, and the occurrence of heart-lung disease. Men and women contributed to the study in 61 and 42 cases, respectively. Smoking was frequent (75% men and 54% women), with a mean tobacco consumption of 36 pack years. Aberrations affecting exclusively the HMGI-C gene and the HGMI(Y) gene were seen in 46 cases (44.7%) and in 22 cases (21.3%), respectively. Both genes were affected in only one case. Abnormalities most frequently occurred in chromosomal bands 6p12 and 12q14. Genetic aberrations were significantly increased in men exposed to environmental (occupational) risk factors, excluding smoking (p < 0.05), and in tumors larger than average hamartomas. There were significant differences in staining profiles, particularly for calcyclin and MIF. The mean proliferation index was Nv = 9.9 +/- 6.4%; structural entropy was similar in all markers applied. Owing to their remarkably high values (from 142 to 148), these data were in contrast to a low current of entropy seen in most markers applied. The staining profile identified several markers that delimited cell positivity from normal parenchymal cells. These results contribute to the definition of biochemical characteristics in hamartomas and can be useful for distinguishing them from chronic degenerative disorders.

Surgical treatment of other bronchial tumors

Bronchial gland tumors (bronchial carcinoids, adenoid cystic carcinoma, mucoepidermoid carcinoma are the most common), benign tumors and other rare primary malignant neoplasms present as endobronchial tumors. This article discusses the surgical treatment of each of these tumors individually.

Diagnosis and staging of "other bronchial tumors"

Unusual bronchial tumors represent 4% to 6% of all lung tumors. These lesions include hamartomas, bronchial carcinoids, adenoid cystic carcinoma, mucoepidermoid carcinoma, and other more rare tumors. In the majority of patients these lesions are diagnosed using transthoracic FNA and different bronchoscopic biopsy techniques such as bronchial lavage, bronchial brushing, endobronchial biopsy, transbronchial biopsy, and transbronchial needle aspiration. Thoracoscopic wedge biopsy is diagnostic in the remainder of cases. Occasionally, because of tumor location, thoracoscopically-guided FNA or thoracoscopic ultrasound are helpful in obtaining a diagnosis. Staging of these lesions is assessed after proper resection; however, mediastinoscopy should be performed if preoperative mediastinal adenopathy is appreciated.