ENDOBRONCHIAL HAMARTOMA: A RARE CAUSE OF WORSENING ASTHMA

Abstract

SESSION TITLE: Fellows Procedures Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary Hamartomas have an incidence of 0.025-0.32% in the general population (1) and almost all are benign. Approximately 10% of them are endobronchial, and may present as refractory asthma. CASE PRESENTATION: A 46-year-old male with previously well controlled asthma, developed worsening respiratory symptoms including shortness of breath and wheezing over the past year. Despite good compliance, inhaler technique and up-titration of his asthma medications, his exacerbations became unpredictable and refractory to further medical therapy. Furthermore, he reported exertional dyspnea and persistent cough and denied sputa, weight loss, hemoptysis, or recent pneumonia. His physical exam revealed a mono-phasic wheeze on auscultation. Dyspnea workup included CT chest (Fig 1), which showed a right main stem endobronchial mass causing near-complete obstruction of the airway. He was referred to our hospital for resection of the mass. A rigid bronchoscopy was done under general anesthesia and a proximal right main bronchus lesion was noted protruding into the distal trachea (Fig 2). The bronchoscope bevel was advanced through the tumor base, with successful core-out of the 1.5cm tumor en bloc. Hemostasis was achieved from tamponade of the tumor base by the rigid scope and further bleeding was controlled with Argon Plasma Coagulation (APC). Post resection, the right bronchus was widely patent without any residual obstruction. He made a complete recovery with immediate post-op improvement in his breathing. Histopathology confirmed it to be a cartilaginous hamartoma (Fig 3). DISCUSSION: Pulmonary hamartomas are rare, benign tumors, originating from the bronchial primitive mesenchymal tissue, which differentiates into various mature components, such as cartilage, bone, fat and muscle tissue. To be classified as a hamartoma, two distinct mesenchymal components native to the organ must be present in a disorganized pattern. Generally, the cartilaginous component is predominant and is classified as a cartilaginous hamartoma. Endobronchial Hamartomas are asymptomatic, until they enlarge to cause bronchial obstruction. Clinical presentation includes persistent cough, dyspnea, wheezing, fever, sputum, hemoptysis or recurrent pneumonia. CT chest may provide a clue to diagnosis by the presence of high fat content in the mass, lack of contrast uptake or extra-bronchial invasion. Needle biopsy of the lesion is frequently inadequate or often misguiding if squamous metaplasia is present in the overlying epithelium. Endoscopic resection is the gold standard treatment. Traditional tracheotomy, wedge resection or lobectomy is reserved for non-resectable lesions or with underlying lung parenchymal damage with recurrence being extremely low. CONCLUSIONS: Endobronchial hamartomas may present as refractory asthma, and prompt evaluation can prevent recurrent hospitalizations, offer a cure and improve quality of life. Reference #1: Endobronchial hamartoma: a rare structural cause of chronic cough by Saman Ahmed et al. Respiratory Medicine Case Reports 22 (2017) 224e227 Reference #2: Endobronchial Hamartoma: literature search and case report. J.F. PATERSON. CHEST, November 1956. Reference #3: A Case Report of Endobronchial Hamartoma: surgical options for resection. Wen Xi. CHEST, April 2016, Vol149, Issue 4. DISCLOSURES: no disclosure on file for Fawad Chaudry; No relevant relationships by Maham Khan, source=Web Response No relevant relationships by Adam Przebinda, source=Web Response No relevant relationships by Aejaz Ul Haq, source=Web Response