Popcorn in the Lung

Abstract

®65-year-old man was admitted for breathlessness and dry cough of 3-month duration. He denied any history of cigarette smoking and asbestos exposure. The patient’s physical examination revealed reduced breath sounds over middleupper right hemithorax. The patient’s laboratory data and vital signs were normal. A posteroanterior chest radiograph showed a large and well circumscribed pulmonary mass on the right side (Fig. 1). Computed tomography scan confirmed a large, solitary, well delimited, round, inhomogeneous, mass of 12 × 8 × 15 mm in size in the right upper lobe, with calcifications of a linear, nodular, irregular shape (Fig. 2). There was no mediastinal or hilar lymphadenopathy. The radiological findings were highly suggestive of a giant pulmonary chondroid hamartoma. Through a muscle sparing lateral thoracotomy, a right upper lobectomy was performed. Histologic examination yielded a well circumscribed hamartoma with predominantly benign chondroid differentiation. The patient was discharged 5 days after surgery. Pulmonary hamartomas are the most common form of benign lung tumors, derived from the peribronchial mesenchyma. The prevalence varies from 0.025% to 0.32% according to different necropsy studies. They are more common in males with a peak incidence in the sixth or seventh decade of life. Pulmonary hamartomas can be divided into parenchymal (90%) and endobronchial (10%) and can be chondromatous or leiomyomatous or a combination thereof. 1 The parenchymal lesions are usually an incidental radiological finding of a round opacity in the periphery of the lung. The presence of calcifications typically dispersed in the form of multiple clumps throughout the lesion in a popcorn configuration can be found in 10–15% of pulmonary hamartomas on chest radiographs. 2 Pulmonary chondroid hamartomas measuring over 10 cm are very rare. 1 Lobectomy is the operation of choice when a giant tumor causes complete replacement of the lobe as in our case.