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Weekly Chest CasesArchive of Old Cases

Case No : 1004 Date 2017-01-23

  • Courtesy of Hee Kang / Kosin University Gospel Hospital
  • Age/Sex 50 / M
  • Chief ComplaintPreoperative systemic evaluation for early colon cancer
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Chondroid harmartoma
Radiologic Findings
Fig 1-2. Chest PA and lateral view show a well defined round nodular opacity in left lower lobe.
Fig 3-5. On CT, about 2cm well-defined solid, non-calcified nodule with lobulated contour is noted in left lower lobe. It demonstrates subtle contrast enhancement.
Fig 6. On PET scan, the nodule shows mildly elevated FDG uptake with maxSUV of 3.3.

Brief Review
Hamartomas are the third most common cause of solitary pulmonary nodule. They account for 6-8% of localized parenchymal masses treated by thoracotomy. Detecting intralesional fat or characteristic calcification can be highly predictive of the diagnosis. However, 50% hamartomas are extremely challenging to diagnose when the lesions does not demonstrate either fat or calcification.
Very few published studies have reported the increased uptake of 18F-FDG in hamartomas. The mechanism of enhanced uptake in hamartomas remains unknown. However, certain studies consider hamartomas to be potentially low grade malignancy, since a small number of cases of squamous cell carcinoma, adenocarcinoma or sarcoma have been reported to arise from pulmonary hamartomas. If malignant cause cannot be excluded, the mass may be excised for diagnosis and with the intent to cure.
References
1) Siegelman SS, Khouri NF, Scott WW, et al. Pulmonary hamartoma: CT findings. Radiology 1986; 160:313-317
2) Himpe U, Deroose CM, Leyb PD, et al. Unexpected slight fluorodeoxyglucose-Uptake on positron emission tomograpy in a pulmonary hamartoma. J Thorac Oncol 2009;4:107-108
3) Wang W, Song J, Shi JG, et al. Slight uptake of 18F-FDG on positron emission tomography in pulmonary hamartoma: A case report Oncol Letters 2015;10:430-432
4) Potente G, Macori F, Caimi M, et al. Noncalcified pulmonary hamartomas: computed tomography enhancement patterns with histologic correlation. J Thorac Imaging 1999;14: 101-104
5) Lee BJ, Kim HR, Cheon GJ, et al. Squamous cell carcinoma arising from pulmonary hamartoma. Clin Nucl Med 2011;36: 130‑131
Keywords
Benign tumor, Lung,

No. of Applicants : 98

▶ Correct Answer : 14/98,  14.3%
  • - Radiologie Mutlangen , Germany JUER MAYER
  • - Irmandade Santa Casa de Miseric泥˜rdia de Porto Alegre , Brazil vicente bohrer brentani
  • - Yale New Haven Health Bridgeport Hospital , United States Puneet Singh Kochar
  • - Other , Korea (South) SUNGTAEK KIM
  • - James Paget Hospital , U.K , United Kingdom nabil sherif mahmood
  • - Samsung medical center , Korea (South) Ran Kim
  • - , Korea (South) park ji hoon
  • - Hospital Federico Abete , Argentina HO KYU LEE
  • - Soonchunhyang University Hospital Seoul , Korea (South) SUNG HWAN BAE
  • - University of Illinois at Chicago , United States GYE YOUNG PARK
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - NIMS, Hyderabad , India AMIT DADHANIA
  • - medical university of isfahan , Iran POUYA AKBARI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
▶ Correct Answer as Differential Diagnosis : 18/98,  18.4%
  • - , Canada ASHISH GUPTA
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Avrasya Hospital , Turkey MURAT ULUSOY
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Seoul National University Hospital , Korea (South) HAN SEUNGCHUL
  • - Kizawa Memorial Hospital , Japan Tomohiro Ando
  • - SQUH , Oman BADRIYA SALEH AL-QASSABI
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - , Korea (South) JUNGMIN LEE
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Medicheck health care , Korea (South) Chae hun Lim
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