Difference between revisions of "Pulmonary hamartoma"

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#redirect [[Pulmonary_pathology#Pulmonary_hamartoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Pulmonary_hamartoma_-_low_mag.jpg
| Width      =
| Caption    = Pulmonary hamartoma. [[H&E stain]].
| Synonyms  =
| Micro      = benign cartilage, adipocytes and respiratory epithelium; lesion without significant nuclear atypia
| Subtypes  =
| LMDDx      =
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = well circumscribed, cartilageous or fatty appearing
| Grossing  =
| Site      = [[lung]] - see ''[[lung tumours]]''
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      = popcorn-type calcifications
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = slow growing [[lung tumours]]
| Tx        =
}}
'''Pulmonary hamartoma''', also '''lung hamartoma''', is a benign lesion of the [[lung]] that may be confused with malignancy.<ref name=pmid18702357>{{Cite journal  | last1 = Wood | first1 = B. | last2 = Swarbrick | first2 = N. | last3 = Frost | first3 = F. | title = Diagnosis of pulmonary hamartoma by fine needle biopsy. | journal = Acta Cytol | volume = 52 | issue = 4 | pages = 412-7 | month =  | year =  | doi =  | PMID = 18702357 }}</ref>
 
==General==
*Benign.
*Malignant transformation reported.<ref name=pmid21220977>{{Cite journal  | last1 = Lee | first1 = BJ. | last2 = Kim | first2 = HR. | last3 = Cheon | first3 = GJ. | last4 = Koh | first4 = JS. | last5 = Kim | first5 = CH. | last6 = Lee | first6 = JC. | title = Squamous cell carcinoma arising from pulmonary hamartoma. | journal = Clin Nucl Med | volume = 36 | issue = 2 | pages = 130-1 | month = Feb | year = 2011 | doi = 10.1097/RLU.0b013e318203bc27 | PMID = 21220977 }}</ref>
*Typically an incidental (radiologic) finding.<ref>{{Cite journal  | last1 = Yang | first1 = C. | last2 = Zhao | first2 = H. | last3 = Yin | first3 = H. | title = [Diagnosis and treatment of pulmonary hamartoma]. | journal = Zhonghua Jie He He Hu Xi Za Zhi | volume = 22 | issue = 7 | pages = 399-400 | month = Jul | year = 1999 | doi =  | PMID = 11775809 }}</ref>
*Treatment: surgical resection.
 
==Gross==
*Well circumscribed lesion.
*Varied morphology.
 
===Radiology===
*Popcorn-type calcifications.<ref name=pmid16369824>{{Cite journal  | last1 = Diederich | first1 = S. | title = [Pulmonary tumors]. | journal = Radiologe | volume = 46 | issue = 2 | pages = 155-64; quiz 165-6 | month = Feb | year = 2006 | doi = 10.1007/s00117-005-1315-x | PMID = 16369824 }}</ref>
**Irregular nodular/linear calcifications.<ref name=pmid19297567>{{Cite journal  | last1 = Park | first1 = CM. | last2 = Goo | first2 = JM. | title = Images in clinical medicine. "Popcorn" calcifications in a pulmonary chondroid hamartoma. | journal = N Engl J Med | volume = 360 | issue = 12 | pages = e17 | month = Mar | year = 2009 | doi = 10.1056/NEJMicm0708685 | PMID = 19297567 }}</ref>
 
==Microscopic==
Features:
*Cartilage - '''key feature'''.
**Single cells in lacunae surrounded by abundant matrix.
***Paucicellular vis-a-vis malignant lesions.
*Fat (adipocytes) - '''key feature'''.
*Respiratory epithelium (columnar epithelium with cilia).
 
Notes:
*No nuclear atypia.
 
DDx:
*Other [[lung tumours]] - especially slow growing ones.
*Myxoid sarcomas, e.g. [[myxoid chondrosarcoma]].
 
===Images===
www:
*[http://forums.studentdoctor.net/showthread.php?t=207741 Pulmonary hamartoma (studentdoctor.net)].
*[http://www.path.utah.edu/casepath/pm%20cases/pmcase8/Hamartoma2.jpg Lung hamartoma (path.utah.edu)].<ref>URL: [http://www.path.utah.edu/casepath/pm%20cases/pmcase8/pmcase8part4.htm http://www.path.utah.edu/casepath/pm%20cases/pmcase8/pmcase8part4.htm]. Accessed on: 9 June 2011.</ref>
<gallery>
Image:Pulmonary_hamartoma_-_low_mag.jpg | Pulmonary hamartoma - low mag. (WC)
Image:Pulmonary_hamartoma_-_intermed_mag.jpg | Pulmonary hamartoma - intermed. mag. (WC)
Image:Pulmonary_hamartoma_-_high_mag.jpg | Pulmonary hamartoma - high mag. (WC)
</gallery>
 
==IHC==
*S100 +ve<ref name=pmid18702357/> - highlights the fat.
 
==Sign out==
===Biopsy===
<pre>
Right Upper Lobe of Lung, Core Biopsy:
    - Chondromyxoid neoplasm, favour pulmonary hamartoma versus chondroma,
      see comment.
    - Scant lung parenchyma, benign.
 
Comment:
The lesion stains with S-100.
</pre>
 
===Excision===
<pre>
LUNG LESION, LEFT UPPER LOBE, WEDGE RESECTION:
- PULMONARY HAMARTOMA WITH MILD FOCAL ACUTE INFLAMMATION AND SURROUNDING EDEMA.
- SURROUNDING LUNG WITH MILD EMPHYSEMATOUS CHANGES.
</pre>
 
====Micro====
The sections show lung with a well circumscribed lesion with a fibrous capsule partially lined by respiratory-type epithelium.  The lesion consists of abundant respiratory epithelium and glands with focal sheeting and small collections of neutrophils focally.  Small foci of degenerative changes are seen.  The epithelium of the lesion as a bland cytomorphology.  Mitotic activity is not readily apparent.  Fat is not identified as a component of the lesion.  Around the periphery of the lesion pulmonary edema is present. 
 
The piece surrounding lung more distant from the lesion has mild emphysematous changes.  No interstitial fibrosis is identified.  No significant inflammation is present.  The arteries are approximately the size of accompanying airway.  The arteries have no appreciable intimal thickening.
 
==See also==
*[[Pulmonary pathology]].
*[[Multifocal micronodular pneumocyte hyperplasia associated with tuberous sclerosis]].
*[[Hamartoma]].
 
==References==
{{Reflist|1}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Pulmonary pathology]]

Latest revision as of 19:21, 24 June 2021

Pulmonary hamartoma
Diagnosis in short

Pulmonary hamartoma. H&E stain.
LM benign cartilage, adipocytes and respiratory epithelium; lesion without significant nuclear atypia
Gross well circumscribed, cartilageous or fatty appearing
Site lung - see lung tumours
Prevalence uncommon
Radiology popcorn-type calcifications
Prognosis benign
Clin. DDx slow growing lung tumours

Pulmonary hamartoma, also lung hamartoma, is a benign lesion of the lung that may be confused with malignancy.[1]

General

  • Benign.
  • Malignant transformation reported.[2]
  • Typically an incidental (radiologic) finding.[3]
  • Treatment: surgical resection.

Gross

  • Well circumscribed lesion.
  • Varied morphology.

Radiology

  • Popcorn-type calcifications.[4]
    • Irregular nodular/linear calcifications.[5]

Microscopic

Features:

  • Cartilage - key feature.
    • Single cells in lacunae surrounded by abundant matrix.
      • Paucicellular vis-a-vis malignant lesions.
  • Fat (adipocytes) - key feature.
  • Respiratory epithelium (columnar epithelium with cilia).

Notes:

  • No nuclear atypia.

DDx:

Images

www:

  • Pulmonary hamartoma - low mag. (WC)

  • Pulmonary hamartoma - intermed. mag. (WC)

  • Pulmonary hamartoma - high mag. (WC)

IHC

  • S100 +ve[1] - highlights the fat.

Sign out

Biopsy

Right Upper Lobe of Lung, Core Biopsy:
     - Chondromyxoid neoplasm, favour pulmonary hamartoma versus chondroma, 
       see comment.
     - Scant lung parenchyma, benign.

Comment:
The lesion stains with S-100.

Excision

LUNG LESION, LEFT UPPER LOBE, WEDGE RESECTION:
- PULMONARY HAMARTOMA WITH MILD FOCAL ACUTE INFLAMMATION AND SURROUNDING EDEMA.
- SURROUNDING LUNG WITH MILD EMPHYSEMATOUS CHANGES.

Micro

The sections show lung with a well circumscribed lesion with a fibrous capsule partially lined by respiratory-type epithelium. The lesion consists of abundant respiratory epithelium and glands with focal sheeting and small collections of neutrophils focally. Small foci of degenerative changes are seen. The epithelium of the lesion as a bland cytomorphology. Mitotic activity is not readily apparent. Fat is not identified as a component of the lesion. Around the periphery of the lesion pulmonary edema is present.

The piece surrounding lung more distant from the lesion has mild emphysematous changes. No interstitial fibrosis is identified. No significant inflammation is present. The arteries are approximately the size of accompanying airway. The arteries have no appreciable intimal thickening.

See also

References

  1. ↑ 1.0 1.1 Wood, B.; Swarbrick, N.; Frost, F.. "Diagnosis of pulmonary hamartoma by fine needle biopsy.". Acta Cytol 52 (4): 412-7. PMID 18702357.
  2. ↑ Lee, BJ.; Kim, HR.; Cheon, GJ.; Koh, JS.; Kim, CH.; Lee, JC. (Feb 2011). "Squamous cell carcinoma arising from pulmonary hamartoma.". Clin Nucl Med 36 (2): 130-1. doi:10.1097/RLU.0b013e318203bc27. PMID 21220977.
  3. ↑ Yang, C.; Zhao, H.; Yin, H. (Jul 1999). "[Diagnosis and treatment of pulmonary hamartoma].". Zhonghua Jie He He Hu Xi Za Zhi 22 (7): 399-400. PMID 11775809.
  4. ↑ Diederich, S. (Feb 2006). "[Pulmonary tumors].". Radiologe 46 (2): 155-64; quiz 165-6. doi:10.1007/s00117-005-1315-x. PMID 16369824.
  5. ↑ Park, CM.; Goo, JM. (Mar 2009). "Images in clinical medicine. "Popcorn" calcifications in a pulmonary chondroid hamartoma.". N Engl J Med 360 (12): e17. doi:10.1056/NEJMicm0708685. PMID 19297567.
  6. ↑ URL: http://www.path.utah.edu/casepath/pm%20cases/pmcase8/pmcase8part4.htm. Accessed on: 9 June 2011.
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