A rare case of asymptomatic giant pulmonary hamartoma.

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.

Association between geographic atrophy progression and reticular pseudodrusen in eyes with dry age-related macular degeneration.

PURPOSE: To evaluate geographic atrophy (GA) progression in eyes with dry AMD and to determine factors related to GA expansion, notably reticular pseudodrusen (RPD), also known as subretinal drusenoid deposits (SDD) or reticular macular disease (RMD). METHODS: This was a retrospective cohort study of patients with dry AMD who were diagnosed with GA in at least one eye and were imaged with sequential fundus autofluorescence (FAF) and/or near infrared reflectance (NIR-R) imaging. Images were analyzed for the presence of GA within the macular region. Geographic atrophy progression was measured in the fields of a modified Wisconsin grid and spatially correlated with RPD. Factors also evaluated for association with GA progression included initial GA size and pattern. RESULTS: The study sample included 126 eyes of 92 patients, with an average follow up of 20.4 months (SD = 11.7). At baseline, 93.6% of eyes had RPD, and the average GA area was 2.8 mm(2) (SD = 2.9). The average GA progression rate was 0.8 mm(2)/y (SD = 0.6), with a statistically significant difference between the unilobular and multilobular phenotype groups (0.3 mm(2)/y vs. 0.9 mm(2)/y, P = 0.02). Patients in the lower 50th percentile of initial GA area had a lower progression rate than patients in the upper 50th percentile (0.6 mm(2)/y vs. 1.1 mm(2)/y, P < 0.001). Geographic atrophy progression was more frequent in fields with RPD than in those without RPD (74.2% vs. 41.7%, P < 0.001). CONCLUSIONS: The high correlation between the presence of RPD (also known as SDD or RMD) and the presence of GA, and the expansion of GA into areas with these lesions suggest that they are an early manifestation of the process leading to GA.