An unusual finding of tumorlet carcinoid and endobronchial hamartoma in the lobar bronchus / Hallazgo inusual de tumorlet carcinoide y hamartoma endobronquial en el bronquio lobar

SUMMARY: Neuroendocrine lung tumours are a group of different tumours that have similar morphological, immunohistochemical and molecular characteristics, and represents 1-2 % of all malignant lung tumours. Tumorlet carcinoids represent the nodular proliferation of hyperplastic neuroendocrine cells that is smaller than 5 mm in size. In this study, we reported the unusual finding of tumour carcinoid and endobronchial hamartoma in the same bronchus. A 49-year-old male patient with symptoms of prolonged severe cough and fever, and was treated for pneumonia. Since he did not adequately respond to antibiotic therapy lung CT scan was performed which showed middle lobe bronchus obstruction. Bronchoscopy revealed a lobulated whitish tumour which was biopsied and histopathological diagnosis was hamartoma. Tumour could not be completely removed during bronchoscopy, it was decided to surgically remove it. On serial section, during gross examination in the same bronchus, an oval yellowish area with a diameter of 3 mm was found along the bronchial wall. According to gross and histomorphological characteristics and immunophenotype of tumour cells, the diagnosis of tumour carcinoid was set. Diagnosis of carcinoids of the tumorlet type is usually an accidental finding and it can be seen on CT in the form of subcentimeter, single or multiple, nodular changes. Considering that the clinical picture is nonspecific, they should always be kept in mind as a possible differential diagnosis.

RESUMEN: Los tumores neuroendocrinos de pulmón son un grupo de tumores de diferentes características morfológicas, inmunohistoquímicas y moleculares similares, y representan el 1- 2 % de todos los tumores malignos de pulmón. Los carcinoides tumorales representan la proliferación nodular de células neuroendocrinas hiperplásicas de tamaño inferior a 5 mm. En este estudio reportamos el hallazgo inusual de tumor carcinoide y hamartoma endobronquial en el mismo bronquio. Un paciente varón de 49 años con síntomas de tos severa prolongada y fiebre fue tratado por neumonía. Al no responder adecuadamente a la terapia con antibióticos, se realizó una tomografía computarizada de pulmón que mostró obstrucción del bronquio del lóbulo medio. La broncoscopia reveló una tumoración blanquecina lobulada de la cual se tomó biopsia y el diagnóstico histopatológico fue hamartoma. No fue posible extirpar el tumor por completo durante la broncoscopia y se decidió extirparlo quirúrgicamente. En la sección seriada, durante el examen macroscópico en el mismo bronquio, se encontró un área amarillenta ovalada de 3 mm de diámetro a lo largo de la pared bronquial. De acuerdo a las características macroscópicas e histomorfológicas y de inmunofenotipo de las células tumorales, se estableció el diagnóstico de tumor carcinoide. El diagnóstico de carcinoides de tipo tumorlet suele ser un hallazgo accidental y se observan en la TC en forma de cambios nodulares subcentimétricos, únicos o múltiples. En consideración de que el cuadro clínico es inespecífico, siempre debe tenerse en cuenta como posible diagnóstico diferencial.

The diagnostic significance of thin layer reconstruction with spiral CT on the pulmonary hamartoma / 实用放射学杂志

Objective To investigate the diagnostic significance of thin layer reconstruction with spiral CT on the pulmonary hamartoma. Methods Accepted both routine CT examination and thin layer construction,2 1 pulmonary hamartoma cases confirmed by pathology were analyzed retrospectively.The margin and inner features of the lesions were observed and recorded.Significant analysis was performed by using SPSS17.0 Pearson chi-square test and Fisher exact test,with P<0.05 as the significant difference criterion.Results Comparison of the display rates by routine CT and thin layer reconstruction:①the same display rate of lobulation were 57.1%(12/21);②the same display rate of calcification were 42.9% (9/21);③the display rates of fat density were 14.3%(3/21)by routine CT and 42.9% (9/21)by thin layer reconstruction.The difference was statistically significant (χ2=4.200,P<0.05);④the display rates of blood vessel throughing were 14.3%(3/21)by routine CT and 47.6% (10/21)by thin layer reconstruction.The difference was statistically significant (χ2=5.459,P<0.05).Conclusion Displaying the inner features of pulmonary hamartoma better than routine CT,the thin layer reconstruction can improve the diagnostic accuracy significantly.

Clinical Analysis of Pulmonary Hamartoma: 37 Cases / 대한흉부외과학회지

BACKGROUND: Pulmonary hamartomas are the most common form of pulmonary benign tumors, and they occur in approximately 2~5% of all pulmonary neoplasm. However, only a few reports have been published on the clinical characteristics of pulmonary hamartoma in Korea. MATERIAL AND METHOD: The charts, X-rays and pathological specimens of 37 pulmonary hamartoma patients who were diagnosed by a pathological examination from January of 2000 to May of 2005 at the Catholic Medical Center were retrospectively reviewed. RESULT: The peak incidence of the tumor occurred in the seventh decade of life (32.4%). There were 23 men (62.6%) and 14 women (37.8%), with mean age of 55.6 years. Twenty-six patients (70.3%) were asymptomatic and 11 patients (29.7%) had symptoms. A total of 29 tumors (78.4%) were parenchymal, and 8 (21.6%) were endobronchial. Twenty cases (54.1%) were in the right lung and 17 cases (45.9%) were in the left lung. The right lower lobe was most commonly involved. Thirty-two (86.5%) hamartomas were diagnosed by surgical resection, 4 cases (10.8%) were diagnosed by bronchoscopic biopsy and 1 case (2.7%) was diagnosed by a fine needle aspiration biopsy. Thirty-four hamartomas (91.9%) were managed by surgical resection without complication. No recurrence or malignant changes were seen during the follow up period. CONCLUSION: Pulmonary hamartomas are most common in males during their fifth to seventh decade and they more commonly involve the right lung. No recurrence or malignant changes were seen during the follow up period.

Use of branchofiberoscopy or video-assisted thoracoscopy in the diagnosis and treatment of pulmonary hamartoma:A report of 43 cases / 中国微创外科杂志

Objective To summarize the experience of the diagnosis and treatment of pulmonary hamartoma.Methods Bronchoscopic enucleation of tumor was conducted in 1 case of endobrochial hamartoma, while video-assisted thoracoscopic surgery was performed in 42 cases(consisting of 40 cases of pulmonary wedge resection,1 case of lobectomy,and 1 case of bilateral lesion biopsy).Results Pathological examinations revealed hamartoma in all the 43 cases,including 1 case of multiple lesions and 1 case of hamartoma complicated with lung cancer.The diagnostic accordance rate was 11.6%(5/43).Follow-up in 37 cases for 4 months~ 11 years(mean,41.2 months) showed no recurrence or malignant change.Conclusions Pulmonary hamartoma is difficult to be confirmatively diagnosed preoperatively.Endoscopic operations can give an accurate diagnosis and a thorough removal of the lesion,with minimal invasion and rapid recovery.

A Case of Pulmonary Hamartoma in Childhood / 소아알레르기및호흡기학회지

Pulmonary hamartoma is uncommon benign tumor-like malformation, which comprises abnormal mixing of the normal components of the lung i.e., cartilage, fat, smooth muscle or respiratory epithelium. The majority occurs in fourth and fifth decades of life, but extremely rare in the pediatric age. Pulmonary hamartoma is clinically classified to endobronchial and intrapulmonary hamartoma. The majority of the pulmonary hamartomas have no clinical symptoms and are detected incidentally by routine chest roentgenograms. But definite diagnosis should be necessary, because of its difficulty to differentiate from malignant and inflammatory lesions. We report a case of intrapulmonary hamartoma which was detected by routine chest roentgenogram check up and diagnosed by fine needle aspiration biopsy and pathological examination with the review of the literature.

The Study of CT Appearances of Pulmonary Hamartoma and Relative Pathology / 实用放射学杂志

Objective To research the appearances of CT and pathology in pulmonary hamartoma so as to improve the CT diagnostic accuracy.Methods The CT and pathological findings of 25 cases of pulmonary hamartoma were analyzed. Dynamic contrast enhancement CT scanning were performed in 17 cases without calcification. All cases were confirmed by surgical operation and pathology.Results All hamartomas had smooth edge on CT. Focal fat without calcification inside were present in 8 of 25 cases, focal fat and calcification inside in 6 of 25 cases (24%), calcification without fat inside in 2 of 25 cases (8%). The CT contrasted value was less than 20 HU in16 of 17 cases (88.24% ). Contrast-enhancing septa were present in 13 of 17 cases(76.47%). The enhancing septa corresponded to loose connective tissue between cartilaginous core. Pathologically, all hamartomas had complete fibrous capsule around them. Cartilage ,broncheal gland, smooth muscle and fibrous connective tissue were found in all cases, and fat and calcification were found in 13 (52%) and 8 (32%) respectively.Conclusion Some specific CT features, including smooth edge, calcification and fat inside, are useful for diagnosis of pulmonary hamartoma. Dynamic contrast enhancement CT scanning is useful for differentiating pulmonary hamartoma with peripheral lung carcinoma.

Fine Needle Aspiration Cytology of Pulmonary Hamartoma / 대한세포병리학회지

Pulmonary hamartomas are uncommon benign tumors, usually discovered radiologically as a solitary coin lesion in asymptomatic individual. The approach to the patient with a peripheral lung nodule has changed with the increasing acceptance of fine needle aspiration cytology(FNAC) as a rapid, safe, inexpensive, and highly accurate diagnostic tool. However, a few reports describing the FNAC findings of pulmonary hamartoma have appeared in the cytologic literature and the experience of FNAC is limited. We reviewed all 9 cases of pulmonary hamartoma with histologic confirmation after FNAC seen at Asan Medical Center since 1995 to evaluate cytologic findings and to determine the value of FNAC in identifying that lesion. Originally, seven of nine patients were diagnosed as pulmonary hamartoma, while two patients were diagnosed as inflammatory lesion and adenocarcinoma of each. On review, eight of nine patients were considered as diagnostic of pulmonary hamartoma. The diagnostic findings in FNAC of pulmonary hamartoma were the presence of fibrillary myxoid tissue with spindle cells as well as hyaline cartilage.

Fine Needle Aspiration Cytology of Pulmonary Hamartoma: A Report of Two Cases / 대한세포병리학회지

Pulmonary hamartoma is an uncommon benign tumor consisting of a mixture of loose fibromyxoid tissue, cartilage, fat, and cleft-like spaces lined by cuboidal or ciliated epithelium. Cytologically, the presence of a mesenchymal component is essential for the diagnosis of pulmonary hamartoma. We report the fine needle aspiration cytologic findings of two cases of pulmonary hamartoma. Case 1 was a 71-year-old woman with a mass, measuring 1.8X1.5 cm in the upper lobe of the right lung. Case 2 was a 51-year-old woman with a mass, measuring 2.3 x 2.0 cm in the lower lobe of the right lung. Fine needle aspiration cytology of both pulmonary masses revealed several sheets of loose fibromyxoid tissue fragments with focal cartilaginous differentiation and a few clusters of bland cuboidal epithelial cells on the bloody background. The diagnosis was histologically confirmed by needle biopsy.

A Case of Crescentic Glomerulonephritis Superimposed on Membranous Glomerulonephropathy

Cytologic findings of pleural effusion in three cases of rhabdomyosarcoma are reported. Case 1 was a pleomorphic rhabdomyosarcoma which had devoped at the chest wall of an elderly male patient and caused pleural effusion. The cytologic features were consistent with pleomorphic rhabdomyosarcoma, that was, showing loose clusters, cellular pleomorphism, and abundant finely vesicular cytoplasm. Cases 2 and 3 were embryonal rhabdomyosarcomas in young adults. Primary site was the oral cavity in case 1, but unknown in case 2 and case 3. The effusion cytology was similar in these cases. Clustered or isolated small round cells with hyperchromatic nuclei and scanty cytoplasm were smeared. The cohesiveness of tumor cells was weak and the cells did not show linear arrangement or nuclear molding. Effusion cytology in a sarcoma patient would be diagnostic when the primary site and the type of sarcoma were already known.

Fine Needle Aspiration Cytology of Pulmonary Hamartoma: 3 cases

Fine needle aspiration cytology of three cases of pulmonary hamartoma is presented. Case 1 was in a 67-year-old man with a 7 cm-sized left lung mass. Case 2 and 3 were in 47 and 53 year old females and consisted of 3 cm and 2 cm-sized right lung nodules, respectively. Fine needle aspiration of the masses revealed several fragments of irregularly shaped mature hyaline cartilage or fibromyxoid mesenchyme and sheets of benign epithelial cells in scanty to acellular background. Also scattered were inflammatory cells including lymphocytes, neutrophils and histiocytes and mature fat cells. These features were diagnostic for pulmonary hamartoma and case 1 was histologically confirmed by following surgical excision of the mass. Differential diagnoses about pulmonary hamartoma in the respect of conditions capable of producing cartilage on fine needle aspiration, were discussed.