Lung hamartomas are usually an incidental radiological finding, as they cause no symptoms. However, some patients do have complaints related to the tumor, such as chest pain [1], hemoptysis, cough, wheezing and dyspnea caused by bronchial obstruction [2]. Because these signs overlap with those of pulmonary carcinoma [3], correct diagnosis is crucial, despite their excellent prognosis [4] [5]. Hamartomas have a slow growth rate [6], but rapid enlargement has also been described [7] and are usually single. When multiple, the Carney triad, consisting of an association between pulmonary chondroma, extra-adrenal paraganglioma and leiomyoblastoma [8] or partial Carney triad- hamartoma along with gastric smooth muscle tumors [9] should be considered.

Malignant transformation of lung hamartomas is possible [10], therefore patients must be periodically evaluated. Single nodules occur in men, whereas multiple tumors are characteristic for women. The condition more often occurs in males within their sixth or seventh decade of life [11].

• Collapse

  At admission, clinical evidence and chest radiographs showed a left upper lobe collapse. A CT scan was interpreted as a possible aspirated foreign body in the left upper lobe bronchus with distal left upper lobe collapse. [emedicine.medscape.com]

  Chest PA view showing right lower lung collapse (Mar. 13 — 1986). Fig. 2. Chest PA view showing improved right lower lung collapse (May 6 — 1986). Fig. 3. CT scan showing a mass obstructing the bronchus intermedius. Fig. 4. [kjim.org]

  If symptoms do appear, they may include the following: Persistent coughing or wheezing Shortness of breath or difficulty breathing Coughing up blood Rattling sounds in the lungs Higher likelihood of pneumonia Lung tissue collapse ### Cleveland Clinic [my.clevelandclinic.org]

• Pathologist

  With over 500 printed photomicrographs and a CD-ROM offering all images in a downloadable format, this is an important resource for all anatomic pathologists. [books.google.de]

  Pathologists newly developed techniques to make diagnoses more involved in day-to-day practice are expected to precise. Until recently, these new techniques have have knowledge of ongoing advances in their field. [books.google.com]

  This procedure may be performed, however no tumor cells may be noted A tissue biopsy refers to a medical procedure that involves the removal of cells or tissues, which are then examined by a pathologist. [dovemed.com]

  So we believed this report can give thoracic surgeons and young pathologists some useful information. [omicsonline.org]

• Sepsis

  As the patient became progressively unwell with signs of chest sepsis and failed to settle with medical therapy, an upper left lobectomy was undertaken. [emedicine.medscape.com]

  Das Medikament nach Anspruch 8, wobei das Medikament ein therapeutisches oder präventives Medikament gegen Sepsis ist. [google.com.na]

• Fishing

  It was conducted experiments on a group of 40 fibroids with apparently normal karyotype FISH, were used for the cosmid and PAC-probes covering the Lokalisierungsort of HMGIC- or HMGIY gene. [google.st]

• Confusion

  One has only to reflect some of which may still be confused with classical dis on the better understanding of many disease processes eases of great antiquity. [books.google.com]

  The triad is not to be confused with the related Carney-Stratakis syndrome or the unrelated Carney complex. [11, 12, 13, 14] A partial Carney triad may be seen when pulmonary hamartomas coexist with smooth muscle tumors of the stomach. [15] Preferred [emedicine.medscape.com]

  Pulmonary hamartoma, also lung hamartoma, is a benign lesion of the lung that may be confused with malignancy. [1] General Benign. [librepathology.org]

  Thus, further investigation with PET-CT of slow-growing, fat-containing masses is unwarranted, confusing, and contributes to patient radiation dose. [radiopaedia.org]

  Not to be confused with hematoma. A hamartoma [2] is a mostly benign, [3] focal malformation that resembles a neoplasm in the tissue of its origin. [en.wikipedia.org]

• Irritability

  If located endobronchially, they can cause irritation of bronchial mucosa resulting in persistent cough as a presenting symptom. [emedicine.medscape.com]

A lung hamartoma may be located in the peripheral areas (most cases) or may be endobronchial [12]. A thoracic radiography typically describes a small, well-circumscribed, possibly lobulated nodule or mass that may contain fat, bone or calcified areas [13]. The pathognomonic radiological aspect is that of "popcorn" calcium deposits, but stippled or curvilinear patterns can be noticed. Lesions can be found in any pulmonary lobe and usually do not cause cavitation. However, a certain diagnosis cannot be established using only plain radiography. A computer tomography (CT) scan offers an accurate description. 60% of lesions contain fat tissue, localized or disseminated inside the tumor and if fat is present and the CT aspect offers a certainty, no further investigations are needed [14]. High-resolution CT offers a better characterization of the architecture of the pathological process, while dynamic computer tomography scans may describe the hemodynamic features [15].

Fludeoxyglucose positron emission tomography shows increased tumor avidity for this tracer. Magnetic resonance imaging (MRI) describes the heterogeneous nature and is usually the modality of choice for Carney triad follow-up [16]. Paraganglioma and other neurogenic malignancies are easily confirmed by iodine-131-meta-iodobenzylguanidine scintigraphy.

Severe consequences are associated with tumors causing bronchial obstruction. In these cases, imaging methods may discover bronchiectasis or destruction of the peripheral pulmonary tissue.

In cases where a clear diagnosis is impossible to make using imaging methods, a percutaneous needle aspiration may be required. Ultrasonography is used to guide this process and is valuable in abdominal Carney triad components identification. If unsuccessful, a biopsy should be performed, or tissue may be analyzed after surgical removal. If the tumor is endobronchial, a transbronchial biopsy via a flexible fiberoptic bronchoscopy is an option [11]. Histological analysis shows fibromyxoid stroma, small, cuboidal or columnar bronchial epithelial cells, fat, bone, smooth muscle, and cartilage.

Blood workup may include the carbohydrate antigen 19-9, that is sometimes present in lung hamartomas [17], while molecular biology, if available, may describe abnormalities of 12q14 and 6q21 domains [18] [19]. Furthermore, patients should be periodically monitored for lung cancer, as they have been demonstrated to have 6.6 times increased risk [20].

• Pulmonary Coin Lesion

  Chondroid hamartomas account for 7-14% of pulmonary coin lesions. [4] Calcifications are often present in a diffuse or popcorn distribution (popcorn calcification). [9] In the CT scan of chest, well-defined sharply marginated lesion showing multiple intralesional [mjdrdypu.org]

1. Lien YC, Hsu HS, Li WY, et al. Pulmonary hamartoma. J Chin Med Assoc. 2004;67:21–26.
2. Thomas JW, Staerkel GA, Whitman GJ. Pulmonary hamartoma. AJR Am J Roentgenol. 1999;172(6):1643.
3. Jacob S, Mohapatra D, Verghese M. Massive chondroid hamartoma of the lung clinically masquerading as bronchogenic carcinoma. Indian J Pathol Microbiol. 2008;51(1):61-2.
4. Zakharov V, Schinstine M. Hamartoma of the lung. Diagn Cytopathol. 2008;36(5):331-2.
5. Guo W, Zhao YP, Jiang YG, et al. Surgical treatment and outcome of pulmonary hamartoma: a retrospective study of 20-year experience. J Exp Clin Cancer Res. 2008;27:8.
6. Hutter J, Reich-Weinberger S, Hutarew G, et al. Giant pulmonary hamartoma--a rare presentation of a common tumor. Ann Thorac Surg. 2006;82(2):e5-7.
7. Adachi Y, Araki K, Metsugi H, et al. A case of relatively rapid enlargement of a pulmonary hamartoma. J Jap Assoc Chest Surg. 2012;26:673-6.
8. Rodriguez FJ, Aubry MC, Tazelaar HD, et al. Pulmonary chondroma: a tumor associated with Carney triad and different from pulmonary hamartoma. Am J Surg Pathol. 2007;31(12):1844-53.
9. Carney JA, Stratakis CA. Familial paraganglioma and gastric stromal sarcoma: a new syndrome distinct from the Carney triad. Am J Med Genet. 2002;108(2):132-9.
10. Basile A, Gregoris A, Antoci B, et al. Malignant change in a benign pulmonary hamartoma. Thorax. 1989;44(3): 232-3.
11. Pollock AB, Al Hasan M, Roy TM, et al. Pulmonary hamartoma- an algorithmic approach to the diagnosis and management. Clin Pulm Med. 2008;15:35-9.
12. Cosío BG, Villena V, Echave-Sustaeta J, et al. Endobronchial hamartoma. Chest. 2002;122(1):202-5.
13. Chai JL, Patz EF. CT of the lung: patterns of calcification and other high-attenuation abnormalities. AJR Am J Roentgenol. 1994;162(5):1063-6.
14. Klein JS, Braff S. Imaging evaluation of the solitary pulmonary nodule. Clin. Chest Med. 2008;29(1):15-38.
15. Jeong YJ, Lee KS, Jeong SY, et al. Solitary pulmonary nodule: characterization with combined wash-in and washout features at dynamic multi-detector row CT. Radiology 2005;237:675–83.
16. Erb RE, Delbeke D, Falke TH. Magnetic resonance imaging of Carney''s triad. South Med J. 1994;87(9):951-5.
17. Okabayashi K, Hiratsuka M, Noda Y et al. Giant hamartoma of the lung with a high production of carbohydrate antigen 19-9. Ann Thor Surg. 1993;55(2):511-513.
18. Johansson M, Dietrich C, Mandahl N et al. Recombinations of chromosomal bands 6p21 and 14q24 characterise pulmonary hamartomas. Br J Cancer. 1003;67(6):1236-41.
19. Bini A, Grazia M, Petrella F, et al. Multiple chondromatous hamartomas of the lung. Interact Cardiovasc Thorac Surg. 2002;1:78–80.
20. Ribet M, Jaillard-Thery S, Nuttens M. Pulmonary hamartoma and malignancy.J Thor Cardiovasc Surg 1994;107(2):611-4.