Chondromatous Hamartoma Research Articles

Nonpolypous Hamartomas of the Gastrointestinal Tract: An Updated Review on Classification, Denominations, and Clinical Management.

Purpose To perform the first systematic report about histological subtypes of nonpolypous hamartomas of the gastrointestinal (GI) tract, from esophagus to anal canal. Design From over 19,000 studies about hamartomas, most of them published as case series or case presentations, we have selected the most representative ones for the GI tract, excluding polyposis syndromes. To have a whole picture of these hamartomas, all of the data were combined with the personal experience of the authors who are GI pathologists. Results The examined articles showed predominance of vascular and combined vascular and mesenchymal hamartomas. Arteriovenous hamartomas or Brunner gland hamartomas are mainly diagnosed in the small intestine, with preponderance for duodenum. Other malformations such cavernous hamartomas are more specific for the colorectal segments, whereas chondromatous hamartomas or those derived from the neural ectoderm were mostly reported in the esophagus. As newly recognized entities were admitted in the last years, misdiagnosis is frequent, and the best therapeutic approach is far to be known. Conclusion Even rare, hamartomas of the GI tract need to be differentiated from tumors and familial polyposis syndromes. Knowing their proper denominations and possible complications is valuable for gastroenterologists, pathologists, and surgeons, to be aware in the differential diagnosis.

ENDOBRONCHIAL HAMARTOMA

SESSION TITLE: Procedures SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Benign tumors of the lung constitute a small portion of all lung neoplasms with Hamartoma being the most common. Hamartoma is a rare benign tumors consisting of multiple mesenchymal cell lines CASE PRESENTATION: 56 Years Old woman presented with abnormal CT chest finding with left upper lobe lung nodule. An incidental finding of right middle lobe endobronchial lesion causing nearly full obstruction of the right middle lobe was seen (figure). The patient endorsed mild dyspnea on exertion with on and off productive cough with clear sputum. The patient denied any fever or chills, weight loss or change in her daily activity. The CT chest compared with a previous images 6 months ago and confirmed the finding of same size right middle lobe endobronchial lesion. Bronchoscopy performed and confirmed the findings of right middle lobe smooth polypoid endobronchial lesion (figure). Hot snare used to debulk the lesion. The lesion removed with no signs of bleeding or blood oozing and tissue sent for pathology. The pathology demonstrated a mix of fat, cartilage and smooth muscle with no evidence of malignancy. DISCUSSION: Pulmonary hamartomas are well known to be the most common benign lung neoplasm with incidence in the general population estimated to be 0.25% and male to female ratio 2:1 to 4:1. According to Bateson; 80.5% of pulmonary hamartomas were intrapulmonary and 19.5% were endobronchial while others like Joseph stated 10.3% were endobronchial and Arrigoni said only 3% were endobronchial. 54.5% of endobronchial hamartomas occur on the right side of the lung while 45.5% occur on the left side. Pulmonary Hamartoma contains mesenchymal and epithelial elements that differentiates into chondroid, adipose and smooth muscle cells. A hamartoma is distinguished from other benign tumors like Chondromas or Lipomas by the presence of at least two mesenchymal elements as compared to the former, which have only one mesenchymal element. Several investigators have reported an association with Carney’s syndrome which consists of chondromatous hamartoma of the lung, extra adrenal paraganglioma, and gastric leiomyosarcoma.Patients with intrapulmonary hamartomas are usually free of symptoms while endobronchial lesions cause variety of symptoms due to bronchial irritation and obstruction which include cough, fever, wheezing, dyspnea and hemoptysis. Complications like post obstructive pneumonia and atelectasis occur. CONCLUSIONS: In conclusion, endobronchial hamartomas are benign neoplasms of the tracheobronchial tree. Endoscopic treatment with flexible bronchoscopic electrocautery is safe and less invasive in experienced hands. Therefore, it should be considered as the primary treatment approach in selected cases. Reference #1: Tomashefski, J. F. 1982 Benign endobronchial mesenchymal tumors: their relationship to parenchymal pulmonary hamartomasAm J Surg Pathol Reference #2: Arrigoni, M. G. 1970 Benign tumors of the lung. A ten-year surgical experienceJ Thorac Cardiovasc Surg Reference #3: The conventional treatment for hamartomas is usually surgical removal due to potential malignant transformation although conservative measures in the form of endoscopic excision can be applied in the absence of chronic post-obstructive lung injury. Most solitary subpleural hamartomas may be removed by enucleation. A wedge resection can be useful if the tumor has become inflamed and involved contagious structures. If the lung distal to the obstruction is irreversibly damaged, lobar resection or even pneumonectomy may be indicated. DISCLOSURES: No relevant relationships by Abdul Hamid Alraiyes, source=Web Response No relevant relationships by Mohamed Elrifai, source=Web Response No relevant relationships by Arun Kadamkulam Syriac, source=Web Response

Endoscopic removal of a chondromatous hamartoma by bronchoscopic electrosurgical snare and argon plasma coagulation

A 31-year-old woman presented with a cough, pain on the left side on deep inspiration, dyspnea, and fever. A chest x-ray showed pneumonic infiltration of the left middle and lower lung and decreased left hemithorax volume. A computed tomography (CT) revealed an occlusion of the left main bronchus by an intraluminal tumour. Bronchoscopic biopsy specimens suggested an endobronchial hamartoma. Therefore, we resected the tumour endobronchially using a bronchoscopic electrosurgical snare and argon plasma coagulation.

Dynamic Computed Tomography Findings of Atypical Pulmonary Hamartoma and It's Pathologic Correlations: A Case Report

Pulmonary hamartoma is the third most frequent cause of solitary pulmonary nodules with an overall prevalence of up to 5.7% (1), and chondromatous hamartoma is the most common type of pulmonary hamartoma (2). Masses are composed of abnormal mixtures of epithelial and mesenchymal elements, such as cartilage, fat, fibromyxoid tissue, smooth muscle, and bone (3, 4). In spite of its relative frequency, no report has been published that details the CT findings of pulmonary hamartomas with rare pathologic patterns, such as fibrous or fibroleiomyomatous types. Here, we describe, for the first time, the unusual contrastenhanced CT findings of pulmonary hamartoma with a predominant fibroblast component and their relations with histopathologic findings. This case report was approved by our Institutional Review Board.

Successful removal of a giant pulmonary hamartoma coexisting with an anomalous common pulmonary venous trunk.

We present an extremely rare case of a giant pulmonary hamartoma (PH) coexisting with an anomalous common pulmonary venous trunk (ACPVT). An asymptomatic 39-year-old man was referred for evaluation of a giant pulmonary lesion in his left thorax detected on chest X-ray during a routine medical examination. After clinical work-up, the patient underwent left exploratory thoracotomy. Since the extent of the tumor and coexistence of an ACPVT, a left pneumonectomy was performed. The specimen measured 28 cm × 18 cm × 17 cm and weighted for 2.1 kg. Histology revealed a blend of pieces of rounded cartilage separated by fibrous bands in which mature adipose tissue and cleft-like structures lined. The features were consistent with those of a chondromatous hamartoma. The patient made a satisfactory recovery and 10 months after the operation was asymptomatic.

Mesenchymal (chondromatous) hamartoma of chest wall in a neonate: A case report and review of literature

Mesenchymal hamartoma of chest wall (MHCW) is a rare benign chest wall tumor mostly presenting at birth or in the first year of life with typical clinical, radiological as well as histopathological features. Here we report a case of this rare entity which can be easily mistaken for a malignant tumor. In this case preoperative probable diagnosis of some malignant tumor was made on clinicoradiological features and the final diagnosis of MHCW was given histopathologically.

Videothoracoscopic identification of chondromatous hamartoma of the lung.

IntroductionThe main disadvantage of a videothoracoscopic procedure is the lack of touch sensation. The probability of easily finding the lesion is usually estimated according to computed tomography (CT).AimTo find useful parameters of location of chondromatous hamartoma of the lung parenchyma in relation to its size to assess the probability of successful search via a videothoracoscopic approach only.Material and methodsA group of 55 patients operated on for chondromatous hamartoma of the lung at the First Department of Surgery in Olomouc from January 2006 to June 2011 was analyzed. Initially, the tumor's longest diameter and its nearest distance to the pleural surface were measured on CT scans. Subsequently, the surgery began using the videothoracoscopic approach. A short thoracotomy with direct palpation followed when videothoracoscopy failed.ResultsNo significant differences in age, sex and side of localization between the group with and without successful videothoracoscopic detection were found. A significant difference was found in the median size (p = 0.026) and the depth of the tumor (p < 0.0001) and in the calculated index “tumor size/depth” (p < 0.0001). Deeper analysis revealed that the parameters “depth” and “index size/depth” are considered to be good predictors but the parameter “size” is not a suitable predictor.ConclusionsThe main predictors of successful videothoracoscopic detection of lung chondromatous hamartoma are considered to be the depth of the tumor in the lung parenchyma with a cut-off value ≤ 7.5 mm and the index “size/depth” with a cut-off value ≥ 1.54; the tumor size is not considered to be a good predictor.

術前に乳癌が疑われた乳腺chondromatous hamartomaの1例

症例は83歳，女性．右乳房の腫瘤を主訴に外来を受診した．右乳房C領域に弾性硬の腫瘤を触知し，マンモグラフィでは境界明瞭平滑な高濃度腫瘤を認め，カテゴリー4と診断した．超音波では内部低エコーの充実性腫瘤を認め，MRI，CTにおいては造影効果を伴う腫瘤影を認めた．針生検では，核の異型や分裂を伴う軟骨化生を示す細胞を認め，乳癌が示唆された．乳癌の可能性も視野にいれ，乳腺部分切除術を施行した．切除標本では，2.8cm大の多結節性病変を認め，明らかな悪性所見は認めず，chondromatous hamartomaの診断であった．乳腺過誤腫は，比較的稀な良性の病変であるが，chondromatous hamartomaはその中でもさらに稀な疾患であり，術前の確定診断は困難である．今回われわれは，術前に乳癌が疑われた乳腺chondromatous hamartomaの1例を経験したので報告する．

Pulmonary chondromatous hamartoma- A rare case report with review of literature

Pulmonary chondromatous hamartoma is a common benign tumor of the lung. It is usually an incidental finding and size ranges from 1 cm to 8 cm in diameter. In routine practice malignant tumours of the lung are encountered most compared to benign tumours. We report a case of a pulmonary chondromatous hamartoma in a 53-year old male who presented with chest pain and respiratory difficulties. A circumscribed tumour measuring 6x5cms was seen in upper lobe of left lung parenchyma with specks of calcification. It was successfully treated by surgical resection and final histology was pulmonary hamartoma with predominantly chondroid and lipomatous differentiation. Following surgery patient symptomatically improved and after 1 year of follow up he is doing well without any complications.

An Endobronchial Chondromatous Hamartoma

Endobronchial chondromatous hamartoma is a very rare benign lung tumor. We report a 68-year-old male patient who presented with a 2-year history of worsening shortness of breath and wheeze, misdiagnosed as having asthma. Computed tomographic scan showed a lesion in the right lower lobe bronchus, and bronchoscopy confirmed the presence of an endobronchial tumor, which was completely excised. Microscopic examination of the tumor showed features of an endobronchial chondromatous hamartoma. The patient made an excellent recovery.

Predominant Cartilaginous Hamartoma: An Unusual Variant of Chondromatous Hamartoma

Chondromatous hamartomas are the most common benign lung tumors and the third most common pulmonary nodule. Histologically, they are characteristically composed of hyaline cartilage mixed with fibromyxoid stroma and adipose tissue surrounded by epithelial cells. We report the case of a healthy, 60-year-old woman with an incidentally discovered chondromatous hamartoma that was thorascopically excised. Her pulmonary hamartoma was predominantly cartilaginous, which only occurs in 1% of hamartomas.

A Lung Mass Causing Cardiovascular Impairment

A Lung Mass Causing Cardiovascular Impairment

Spontaneous neoplasms observed in cynomolgus monkeys ( Macaca fascicularis) during a 15-year period

A total of 33 tumors were observed during a time period of 15 years (1992–2006) in cynomolgus monkeys. The great majority of neoplasms was benign (23 benign neoplasms versus 10 malignant tumors). Fourteen appeared in males and 19 in females. The age of tumor-bearing animals ranged between 2 years 2 months and 13 years 9 months. Most of the tumors (22) in the cynomolgus monkeys were seen in endocrine organs (adrenal cortical adenoma, adrenal hemangioma, C-cell carcinoma, follicular adenoma), respiratory system (nasal cavity adenoma, pulmonary squamous cell carcinoma, bronchio-alveolar carcinoma, bronchiolar papilloma, chondromatous hamartoma) and female genital system (uterine polyp, uterine adenoma, uterine leiomyoma and teratoma of the ovary). Four animals revealed malignant lymphoma infiltrating multiple organs.

Laser-Assisted Resection of a Giant Pulmonary Chondrohamartoma - A Case Report

A rare case of a giant pulmonary chondromatous hamartoma (15 cm, 1350 g) resected by a new laser system (Nd:YAG, 1318 nm, 40 W) is presented. The laser management of a hamartoma resection--the largest reported to date in the literature--is presented here.

Posterior Mediastinal Chondromatous Hamartoma

A posterior mediastinal mass was found incidentally in a 70-year-old woman during a work-up for an early breast cancer. Computed tomography of the chest showed a well-circumscribed mass near the left subclavian artery and proximal descending aorta. A left video assisted thorascopic excision of the posterior mediastinal mass was performed. Pathologic examination showed it to be a chondromatous hamartoma, representing a very unusual location for this type of tumor.

胸腔内播種を認めた肺過誤腫の1切除例

過誤腫は軟骨・脂肪・気管支上皮などからなる良性腫瘍で，周囲臓器への浸潤は稀で播種性転移の報告はない．今回我々は胸腔内播種を認めた症例を経験したので，若干の考察を加え報告する．

Chondromatous Hamartoma of the Chest Wall: Description of 3 New Cases and Literature Review

Chondromatous hamartoma of the chest wall is an extremely rare, benign lesion that usually occurs in early infancy. It typically arises in the rib cage and produces a large mass. It is composed of a varying admixture of hyaline cartilage that has features resembling growth plate cartilage, fascicles of spindle cells, woven bone, and hemorrhagic cysts. Treatment consists mainly of surgical excision, which is usually curative. We present 3 new cases, which demonstrated interesting findings, including multicentricity, involvement of the sternum, and local recurrence, and we discuss these findings in the context of a literature review.

Recurrent hamartoma at the trocar incision site after video-assisted thoracic surgical resection

T he most common benign tumor of the lung is the hamartoma representing 77%. Hamartomas represent 4% to 8% of all solitary pulmonary nodules, which present themselves as well-circumscribed, asymptomatic coin lesions within the pulmonary parenchyma. Usually they are chondromatous hamartomas consisting of cartilage and are regarded as benign neoplasms derived from the peribronchial mesenchymal tissue. Symptoms such as cough, hemoptysis, or pulmonary infections arise only when the location is endobronchial, which is rare (10%). There is an overall incidental finding in approximately 0.25% of autopsies, and hamartomas are found more frequently in men than in women (2:1). Multiple hamartomas are rare and do not include cartilage but pulmonary muscular or endothelial tissue and are therefore called hemangioleiomyomatous and fibroleiomyomatous hamartomas. In the case of a solitary lesion it is necessary to exclude malignancy. Percutaneous, transthoracic computed tomographyguided needle aspiration biopsy yields diagnosis in 85% of solitary pulmonary coin lesions. The risk of pneumothorax is high, ranging from 20% to 24%. Video-assisted thoracic surgical (VATS) resection offers a safe and 100% sure method to obtain a diagnosis with little discomfort for the patient. Most authors recommend enucleation or tissue-sparing resection of the chondromatous hamartoma. Recurrence after excision is practically unknown.

Radiological Findings of Giant Pulmonary Chondromatous Hamartoma: Case Report

Among lung tumors, multiple hamartomas are uncommon and multiple chondromatous hamartomas are extremely rare. In this report, we describe a patient with an interval growth of a giant chondromatous hamartoma with accompanying multiple satellite nodules in the adjacent lung and the parietal pleura. We also present the follow up chest radiograph, computed tomograph, magnetic resonance images and photographs of the operating field of the tumor with pathologic correlation.

Chondromatous Hamartoma of the Lung: A Case of Unusually Rapid Growth and Recurrence

Pulmonary hamartomas are benign neoplasms generally considered to be derived from undifferentiated mesenchymal tissue of bronchial walls [1]. Cytogenetic studies have identified recombination of chromosomal bands 6p21 and 14q24, supporting the view that hamartomas are clonal mesenchymal neoplasms [2]. Hamartomas occur most frequently in middle-aged or elderly adults, with the peak incidence in the sixth or seventh decade of life. The majority of patients with hamartomas are male in most studies. Diagnosing chondromatous hamartomas by non-invasive means is difficult when hamartomas do not show foci of calcium or fat on computed tomography (CT). In a report of 30 uncalcified hamartomas diagnosed by surgical resection, cartilaginous tissue enhanced less on CT regardless of the presence of enhanced septa, which was dependent on the loose connective tissue within the cartilaginous core [3]. Pulmonary hamartomas are benign lesions with little or no risk of malignant transformation and minimal risk of recurrence. The current report describes the imaging and clinical findings of a patient with chondromatous hamartomas of the lung with several unusual features.