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pulmonary parenchymal hamartoma

Wednesday 26 September 2012

Pulmonary mesenchymoma

Digital cases

- JRC:6365: Lung parenchymal hamartoma.

Definition: Pulmonary hamartomas or mesenchymomas are the most common form of benign lung tumours.

Epidemiology

Pulmonary hamartomas or mesenchymomas are the most common form of benign lung tumours with an incidence of between 0.025% – 0.32% according to different necropsy studies.

In a large series they constituted 7–14% of all coin lesions.

Most of these are parenchymal lesions with endobronchial lesions making up only about 10%.

The peak incidence is between the sixth and seventh decades with a male preponderance.

Clinical synopsis

The parenchymal lesions are usually an incidental radiological finding of a round homogeneous opacity in the periphery, whereas endobronchial lesions are usually associated with haemoptysis and obstructive pneumonia.

The size of these parenchymal lesions ranges from 1–8 cm and the tumour in our case is more than 3 times that of any previously published.

Microscopy

The histology of the parenchymal lesions usually reveals a predominant chondroid differentiation (80%), with fibroblastic (12%), fatty (5%) and osseous (3%) differentiation making the rest.

The lesion can be predominantly made of adipose and leiomyomatous differentiation.

Variants

- pulmonary mesenchymal cystic hamartoma

See also

- pulmonary hamartomas

References

- Cosio BG, Villena V, Echave-Sustaeta J, de Miguel E, Alfaro J, Hernandez L, Sotelo T: Endobronchial hamartoma. Chest 2002, 122(1):202-5.

- Ray JF 3rd, Lawton BR, Magnin GE, Dovenbarger WV, Smullen WA, Reyes CN, Myers WO, Wenzel FJ, Sautter RD: The coin lesion story: update twenty years experience with early thoracotomy for 179 suspected malignant coin lesions. Chest 1976, 79:332-6.

- Gjevre JA, Myers JL, Prakash UB: Pulmonary hamartomas. Mayo Clin Proc 1996, 71(1):14-20.

- Vanden Bosch JMM, Wagenaar SS, Corrin B, Elbers JRJ, Knaepen PJ, Westermann CJJ: Mesenchymoma of the Lung (so called hamartomas): a review of 154 parenchymal and endobronchial cases. Thorax 1987, 42:790-793.

- Ribet CM, Jaillard-Thery S, Nuttens MC: Pulmonary hamartoma and malignancy. J Thorac Cardiovasc Surg 1994, 107(2):611-4.

- Salminen US: Pulmonary hamartoma. A clinical study of 77 cases in a 21-year period and review of literature. Eur J Cardiothorac Surg 1990, 4(1):15-8.

- Colby TV, Koss MN, Travis WD: Tumours of the Lower Respiratory Tract. In Atlas of Tumor Pathology. Washington, DC Armed Forces Institute of Pathology; 1994:319-25.

- Glezos J, Toppin D, Cooney T. Mesenchymal cystic hamartoma presenting with spontaneous pneumothorax. Can Respir J. 2003 Jul-Aug;10(5):280-1. PMID: #12945006#

- Cottin V, Thomas L, Loire R, Chalabreysse L, Gindre D, Cordier JF. Mesenchymal cystic hamartoma of the lung in Cowden’s disease. Respir Med. 2003 Feb;97(2):188-91. PMID: #12587971#

- Chadwick SL, Corrin B, Hansell DM, Geddes DM. Fatal haemorrhage from mesenchymal cystic hamartoma of the lung. Eur Respir J. 1995 Dec;8(12):2182-4. PMID: #8666115#

- van Klaveren RJ, Hassing HH, Wiersma-van Tilburg JM, Lacquet LK, Cox AL. Mesenchymal cystic hamartoma of the lung: a rare cause of relapsing pneumothorax. Thorax. 1994 Nov;49(11):1175-6. PMID: #7831639#

- Leroyer C, Quiot JJ, Dewitte JD, Briere J, Clavier J. Mesenchymal cystic hamartoma of the lung. Respiration. 1993;60(5):305-6. PMID: #8284530#

- Meza MP, Newman B, Dickman PS, Towbin RB. Pediatric case of the day. Pulmonary mesenchymal cystic hamartoma. Radiographics. 1992 Jul;12(4):843-4. PMID: #1636044#

- Hedlund GL, Bisset GS 3rd, Bove KE. Malignant neoplasms arising in cystic hamartomas of the lung in childhood. Radiology. 1989 Oct;173(1):77-9. PMID: #2781034#

- Abrams J, Talcott J, Corson JM. Pulmonary metastases in patients with low-grade endometrial stromal sarcoma. Clinicopathologic findings with immunohistochemical characterization. Am J Surg Pathol. 1989 Feb;13(2):133-40. PMID: #2916727#

- Bove KE. Sarcoma arising in pulmonary mesenchymal cystic hamartoma. Pediatr Pathol. 1989;9(6):785-92. PMID: #2602233#

- Mark EJ. Mesenchymal cystic hamartoma of the lung. N Engl J Med. 1986 Nov 13;315(20):1255-9. PMID: #3773938#

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