Dynamic Computed Tomography Findings of Atypical Pulmonary Hamartoma and It's Pathologic Correlations: A Case Report
- Affiliations
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- 1Department of Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea. jw@pusan.ac.kr
- 2Department of Thoracic and Cardiovascular Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
- 3Department of Pathology, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
- KMID: 2208779
- DOI: http://doi.org/10.3348/jksr.2016.74.4.226
Abstract
- We present the dynamic contrast-enhanced computed tomography (CT) findings of atypical pulmonary hamartoma with a rare histologic pattern in a 20-year-old male. CT showed a 3.4 cm lobulated mass with a 'tip of the iceberg' appearance in the medium bronchus of the right lower lobe. Dynamic contrast-enhanced CT demonstrated a heterogeneously and persistently enhancing mass. The CT Hounsfield unit (HU) measurements were: 17 HU pre-contrast, 32 HU at 1 minute, 44 HU at 2 minutes, 51 HU at 4 minutes, and 64 HU at 15 minutes. Pathologic examination after video-assisted thoracoscopic surgery disclosed a pulmonary hamartoma with a predominant fibroblastic component.
MeSH Terms
Figure
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Fig. 1 20-year-old male with pulmonary fibroblastic hamartoma. A. Chest radiograph demonstrating the presence of a lobulated mass in the right lower lung field. B. Axial contrast-enhanced chest CT image with mediastinal setting (left) and oblique two-dimensional coronal reformatted image with lung setting (right) showing a 3.4 cm mass in the posterior basal segment of the right lower lobe. The mass consists of small endobronchial (arrows) and large extrabronchial components, suggestive of the 'tip of the iceberg' sign. C. Dynamic contrast-enhanced CT image showing persistent enhancement with a net enhancement of 47 Hounsfield units (HU). Non-contrast CT provides no evidence of fatty deposits or calcification. The CT HU measurements are 17 HU pre-contrast, 21 HU at 0.5 minute, 32 HU at 1 minute, 41 HU at 1.5 minutes, 44 HU at 2 minutes, 51 HU at 4 minutes, 57 HU at 5 minutes, and 64 HU at 15 minutes. D. Hematoxylin and eosin (H&E) staining showes that the tumor was composed predominantly of spindle cells, adipose tissue, and blood vessels. In addition, normal-looking pulmonary alveoli and bronchi are seen inside the tumor (× 40). E. Spindle cells has elongated nuclei with inconspicuous nucleoli and are arranged in short fascicles in a collagenous background (H&E staining, original magnification × 200).
Reference
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1. Bhatia K, Ellis S. Unusual lung tumours: an illustrated review of CT features suggestive of this diagnosis. Cancer Imaging. 2006; 6:72–82.2. Lien YC, Hsu HS, Li WY, Wu YC, Hsu WH, Wang LS, et al. Pulmonary hamartoma. J Chin Med Assoc. 2004; 67:21–26.3. Saqi A, Shaham D, Scognamiglio T, Murray MP, Henschke CI, Yankelevitz D, et al. Incidence and cytological features of pulmonary hamartomas indeterminate on CT scan. Cytopathology. 2008; 19:185–191.4. Cho W, Jeong YJ, Lee CH, Lee JW, Kim KI, Yeom JA, et al. Dynamic CT findings of pulmonary hamartoma: a comparison with histopathologic findings. J Korean Soc Radiol. 2013; 69:449–455.5. Geraghty PR, Kee ST, McFarlane G, Razavi MK, Sze DY, Dake MD. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology. 2003; 229:475–481.6. Bryan C, Andrew N. Pathology of the lungs. 3rd ed. London: Churchill Livingstone;2011.7. Cosío BG, Villena V, Echave-Sustaeta J, de Miguel E, Alfaro J, Hernandez L, et al. Endobronchial hamartoma. Chest. 2002; 122:202–205.8. Siegelman SS, Khouri NF, Scott WW Jr, Leo FP, Hamper UM, Fishman EK, et al. Pulmonary hamartoma: CT findings. Radiology. 1986; 160:313–317.9. Jeong YJ, Lee KS, Jeong SY, Chung MJ, Shim SS, Kim H, et al. Solitary pulmonary nodule: characterization with combined wash-in and washout features at dynamic multi-detector row CT. Radiology. 2005; 237:675–683.
