MedPix® Patient Chart - Case No: 12410 :: - Review Images

58 yo man presented with neck pain to his primary care physician. An MRI of the cervical spine was obtained revealing an abnormal finding.

- Review Images for PT: 12410

T2 weighted axial MR image reveals a well-marginated mass with smooth borders in the left lung at the level of the aortic arch, which demonstrates multiple small foci of increased T2 signal intensity, giving the mass a speckled appearance.

Contrast enhanced axial CT image shows a homogeneous, well-marginated, solid mass with minimal contrast enhancement in the left upper lobe. No fat or calcification is evident.

- Review Images for PT: 12410

• Tuberculoma
• Metastatic Disease
• Carcinoid Tumor
• Adenocarcinoma
• Small-cell carcinoma
• Pulmonary hamartoma

- Review Images for PT: 12410

Dx: Atypical Pulmonary Hamartoma

Dx Confirmed by: Patient underwent biopsy, with histological evaluation.

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The biopsy demonstrated cartilage lobules without intervening stroma, and sparse cellularity. Additionally, respiratory epithelium was visualized lining the margin of the mass and invaginating into the mass forming multiple small cystic areas, with fat tissue intermixed within adjacent respiratory epithelium, consistent with chondromatous hamartoma.

Lesions/Condition: Pulmonary Hamartoma

Predisposing Factors:

Most commonly occurs in the fourth to fifth decade. Most common chromosomal abnormality involves the q13-q15 region of chromosome 12.

Symptoms:

Most patients presenting with peripheral pulmonary hamartomas are asymptomatic. When symptomatic, hemoptysis is the most common presenting symptom.

Discussion:

Pulmonary hamartomas are benign neoplasm with 90% arising within the lung parenchyma, and are usually in a peripheral location. They comprise approximately 5% of all solitary pulmonary nodules. Pulmonary Hamartomas contain cartilage surrounded by fibrous connective tissue with variable amounts of fat, smooth muscle, and seromucous glands. Approximately 30% contain calcium in the form of multiple clumps (‘popcorn’ calcification).

Generally, pulmonary hamartomas can be observed by CT alone. Indications for transthoracic biopsy or resection are rapid growth, a size greater than 2.5 cm, or new pulmonary symptoms.

Radiology:
   
Chest Radiographs:
Well-circumscribed, smoothly marginated solitary nodule without lobar predilection. Most pulmonary hamartomas are smaller than 4 cm in diameter. Calcification is visible in less than 10% of cases.

CT:
Well-circumscribed nodule with a smooth or lobulated border.
Composed entirely of fat, a mixture of fat and soft tissue, or fat and calcification. Calcification when present is in the form of multiple clumps of calcium dispersed throughout the lesion (“popcorn� calcification)