대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pulmonary harmatoma

Radiologic Findings

The patient has underlying emphysematous lung. In the right lower lobe, we can see a 7.5cm mass with adjacent multicystic space and satellite nodules. Precontrast image shows no calcification (not shown). The mass was heterogeneously enhanced. Some portions are very well enhanced in 1 minute delayed image, whereas some portion remained unenhanced with low attenuation less than 20HU. On FDG-PET, the mass does not show hypermetabolism.
PCNB was non diagnostic. RLL anterobasal segmentectomy was performed and revealed pulmonary hamartoma with exuberant hyperplasia of entrapped alveolar epithelium.

Brief Review

Cystic pulmonary hamartomas are usually quite rare. These cystic hamartomas were initially misinterpreted as tuberculomas, echinococcal cysts, congenital or acquired cysts, as well as carcinomas. Controversies regarding the histogenesis of cystic pulmonary hamartomas have existed for several decades; however, their synthesis remains uncertain. Pulmonary hamartomas commonly have small epithelial-lined tubules resembling bronchioles within the connective tissue septa that divide the various components of the tumor. One proposed theory for cyst formation within hamartomas is that those epithelia serve as the route of air entry into the lesions. Once a continuity exists between these tubules within the bronchial tree. A checkvalve mechanism might result in the gradual expansion of these epithelial-line tubules and finally an air-filled cavity enveloping and containing into the original hamartoma.

Please refer to Case 37, 146, 308, 429, 531, and 636.

References

Doppman, J. and G. Wilson (1965). "Cystic Pulmonary Hamartoma." Br J Radiol 38: 629-631.
Kim, G. Y., J. Han, et al. (2005). "Giant Cystic Chondroid Hamartoma." J Korean Med Sci AID - 10.3346/jkms.2005.20.3.509 [doi] 20(3): 509-511.
Miura, K., T. Hori, et al. (1990). "Cystic pulmonary hamartoma." Ann Thorac Surg 49(5): 828-829.
Mushtaq, M., S. P. Ward, et al. (1992). "Multiple cystic pulmonary hamartomas." Thorax 47(12): 1076-1077.
Yamakawa, Y., T. Mizuno, et al. (1986). "[A case of giant cystic pulmonary hamartoma]." Nihon Kyobu Geka Gakkai Zasshi 34(9): 1720-1724.
EY Yoo, KS Lee, et al. (2008). "Cystic Pulmonary Chondroid Hamartoma: A Case Report." J Korean Radiol Soc 58(6): 579-581.

Keywords

lung, benign tumor,