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Difference between revisions of "Pulmonary hamartoma"
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'''Pulmonary hamartoma''' is a benign lesion of the [[lung]] that may be confused with malignancy. | {{ 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== | ==General== | ||
*Benign. | *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== | ==Gross== | ||
*Well circumscribed lesion. | *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== | ==Microscopic== | ||
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Notes: | Notes: | ||
*No nuclear atypia. | *No nuclear atypia. | ||
DDx: | |||
*Other [[lung tumours]] - especially slow growing ones. | |||
*Myxoid sarcomas, e.g. [[myxoid chondrosarcoma]]. | |||
===Images=== | ===Images=== | ||
| Line 31: | Line 72: | ||
==IHC== | ==IHC== | ||
*S100 +ve - highlights the fat. | *S100 +ve<ref name=pmid18702357/> - highlights the fat. | ||
==Sign out== | ==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> | <pre> | ||
LUNG LESION, LEFT UPPER LOBE, WEDGE RESECTION: | LUNG LESION, LEFT UPPER LOBE, WEDGE RESECTION: | ||
| Line 40: | Line 93: | ||
</pre> | </pre> | ||
===Micro=== | ====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 | 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. | 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. | ||
| Line 47: | Line 100: | ||
==See also== | ==See also== | ||
*[[Pulmonary pathology]]. | *[[Pulmonary pathology]]. | ||
*[[Multifocal micronodular pneumocyte hyperplasia associated with tuberous sclerosis]]. | |||
*[[Hamartoma]]. | |||
==References== | ==References== | ||