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Lung tumor

Benign tumors

Hamartoma


Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 8 January 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Solitary, subpleural islands of mature hyaline cartilage, fat, smooth muscle and clefts lined by respiratory epithelium
● Also called pulmonary chondroma, although chondromas in Carney triad have thin fibrous pseudocapsule, frequent bone metaplasia, calcification, and lack entrapped epithelium and fat (Am J Surg Pathol 2007;31:1844)
● Benign, occurs in adults
● Common, presents as incidental coin lesion (rounded abnormality) with popcorn pattern of calcification on chest Xray
● May present as intrabronchial polypoid mass causing obstruction
Nonfamilial syndrome: pulmonary chondroma, gastric epithelioid leiomyosarcoma, functional extra-adrenal paraganglioma

Case reports
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● Pulmonary hamartoma with salivary gland-type tumors showing myoepithelial differentiation (Am J Surg Pathol 2006;30:375)

Treatment
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● Excision is curative

Radiologic images
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Chest Xray contributed by Dr. Hanni Gulwani, New Delhi (India)


CT scan contributed by Dr. Hanni Gulwani, New Delhi (India)

Gross description
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● 4 cm or less, sharply delineated and lobulated, glistening cut surface (cartilage) with ill defined clefts

Gross images
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Various images


Lobulated tumor contributed by Dr. Hanni Gulwani, New Delhi (India)

Micro description
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● Principally composed of islands of mature hyaline cartilage, fat, smooth muscle and clefts lined by respiratory epithelium (ciliated or not)
● Cartilage may be calcified or ossified
● Periphery of cartilage may contain immature myxomatous tissue
● Resembles breast fibroadenoma if no cartilage present
● 15% have papillary projections resembling immature placental villi (placental transmogrification), with stromal macrophages and lymphocytes and abundant mast cells (Arch Pathol Lab Med 2002;126:562)

Micro images
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Various images


Placental transmogrification


Lung hamartoma contributed by Dr. Hanni Gulwani, New Delhi (India)

Virtual slides
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Various images

Differential diagnosis
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Benign metastasizing leiomyoma
Leiomyosarcoma
Lymphangioleiomyomatosis
● Native pulmonary muscle proliferation
Mesenchymal cystic hamartoma
● Chronic interstitial pneumonitis-reactive smooth muscle proliferation


Multiple pulmonary leiomyomatous hamartomas

General
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● Very rare, almost always asymptomatic middle-aged women

Case reports
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● 31 year old woman whose tumors had secondary ossification (Pathol Int 1999;49:222)
● 46 year old man associated with bronchogenic cyst (Arch Pathol Lab Med 2003;127:e194)

Micro description
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● Excessive smooth muscle, not associated with tumor nodules

Micro images
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Smooth muscle proliferations

Negative stains
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● HMB45

End of Lung tumor > Benign tumors > Hamartoma


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