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HISTOPATHOLOGY SECTION - CASE REPORT Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 1  |  Page : 61-62
Massive chondroid hamartoma of the lung clinically masquerading as bronchogenic carcinoma


1 Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Cardiothoracic Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India

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   Abstract 

Chondroid hamartomas of the lung are uncommon lesions which are generally small sized and asymptomatic. Herein we describe a case of a large-sized pulmonary chondroid hamartoma which clinically mimicked bronchogenic carcinoma. A large hilar growth was detected in the left lung on radiological studies. Left upper lobectomy was done. The growth was well defined with a lobulated bluish cut surface. Histopathology disclosed lobules of mature cartilage rimmed by long slit-like epithelial channels admixed with mature adipose tissue.

Keywords: Chondroid hamartoma, hamartoma, lung, tumor-like lesions

How to cite this article:
Jacob S, Mohapatra D, Verghese M. Massive chondroid hamartoma of the lung clinically masquerading as bronchogenic carcinoma. Indian J Pathol Microbiol 2008;51:61-2

How to cite this URL:
Jacob S, Mohapatra D, Verghese M. Massive chondroid hamartoma of the lung clinically masquerading as bronchogenic carcinoma. Indian J Pathol Microbiol [serial online] 2008 [cited 2020 Oct 21];51:61-2. Available from: https://www.ijpmonline.org/text.asp?2008/51/1/61/40400



   Introduction Top


Chondroid hamartomas are rare benign lesions of the lung comprising 8% of all lung tumors. [1] They are usually small-sized, solitary, peripherally located, and asymptomatic lesions detected incidentally on chest X-ray or at autopsy. Rarely, they may be large in size [2] and may clinically mimic malignancy. [3]


   Case History Top


A 58-year-old lady presented with a 3-month history of cough and chest pain which was increasing in severity. There was no history of smoking or weight loss. Chest X-ray and computerized tomography (CT) scan showed a 5 x 5 cm 2 fairly well-defined mass in the upper lobe of the left lung, perihilar in location. Enlarged hilar lymph nodes were also noted. Bronchoscopic examination was normal. Fine needle aspiration cytology (FNAC) of the mass yielded scanty material and hence was inconclusive. Bronchoalveolar lavage was also nondiagnostic. With a clinical diagnosis of bronchogenic carcinoma, the patient underwent left upper lobectomy.

Pathological findings

The lobectomy specimen showed a large, well-circumscribed and lobulated growth measuring 6 x 6 x 5 cm 3 at the hilum. The growth was firm and rubbery in consistency with a pale bluish cut surface [Figure - 1]. There was no endobronchial extension of the growth. The main bronchus and the rest of the lung parenchyma were grossly normal. Microscopic examination of multiple sections taken from the growth showed predominantly large lobules and islands of mature cartilage separated by abundant adipose tissue and small amount of loose fibromyxoid stroma. Deeply invaginated cleft-like spaces lined by pseudo-stratified columnar/cuboidal epithelium rimming the cartilaginous tissue were present at places [Figure - 2]. There was no evidence of malignancy. The surrounding lung parenchyma was unremarkable. The resected hilar lymph nodes showed reactive hyperplasia.


   Discussion Top


Pulmonary chondroid hamartoma was first described by Albrecht in 1904. It is also known as hamartochondroma, chondromatous hamartoma, adeno- chondroma, and mesenchymoma. [4] Chondroid hamartomas of lung are usually found in adults with a peak incidence in the sixth decade. [5] There is a male preponderance, the male:female ratio being 2:1 to 3:1. [5]

Chondroid hamartomas are usually solitary and well circumscribed, with maximum dimensions usually ranging from 1 to 4 cm with an average of 2 cm. Rarely, they may be of large size [2] and sometimes they may be multiple. [3] Depending upon the location in the lung, pulmonary chondroid hamartomas are of two types, viz ., peripheral parenchymal type and central endobronchial type. The former comprises over 90% of all chondroid hamartomas, arises from small bronchi and is generally asymptomatic. [4] The endobronchial type arises from large bronchi, is less frequent but is often associated with symptoms of obstruction. [3] Radiologically, chondroid hamartomas accounts for 7-14% of pulmonary coin lesions. Some cases show popcorn pattern of calcification.Transthoracic FNAC can be used to establish the diagnosis in some cases. [5],[6] The cytologic diagnosis is based on the recognition of mesenchymal components characterized by fibromyxoid stroma and chondroid elements. [6]

Chondroid hamartoma histologically consists of islands of cartilage, fat, fibromyxoid stroma, and narrow spaces lined by respiratory epithelium. The endobronchial type may contain a greater proportion of fat and less of epithelial lined spaces. [4] Histologically, chondroid hamartomas need to be differentiated from conditions like bronchial chondroma and cystic blastoma. Bronchial chondroma lies in continuity with the bronchial cartilage and lacks the mixture of mesenchymal elements seen in chondroid hamartoma. Cystic blastomas can be distinguished by the presence of a cambium layer of embryogenic mesenchyme adjacent to the epithelial lining and by the immaturity of the cartilage, fat, and muscle.

In recent times, the concept of chondroid hamartomas has been questioned as they are seen to be associated with abnormal karyotypes which point to a neoplastic nature. [7] Cytogenetic studies of chondroid harmartomas reveal a neoplastic transformation of primitive mesenchymal cells differentiated along chondroid, adipose, and smooth muscle pathways. [8] Recurrence of chondroid hamartoma is extremely unusual and malignant transformation is exceptional. [9]

In conclusion, chondroid hamartoma is a rare benign lesion of the lung which is completely cured by surgical removal. Although an overwhelming majority is small, peripherally located, and asymptomatic, occasionally it may present as large hilar mass and clinically mimic malignancy.

 
   References Top

1.Jones RC, Cleve EA. Solitary circumscribed lesions of lung. Arch Intern Med 1954;93:842-51.  Back to cited text no. 1    
2.Jackson RC, Mc Donald JR, Clagett OT. Massive cystic pulmonary hamartoma. J Thorac Surg 1956;31:504.  Back to cited text no. 2    
3.King TE, Christopher KL, Schwarz MI. Multiple pulmonary chondromatous hamartomas. Hum Pathol 1982;13:496-7.  Back to cited text no. 3    
4.Bateson EM. Relation between intrapulmonary and endobronchial cartilage-containing tumours (so called hamartomata). Thorax 1965;20:447-61.  Back to cited text no. 4    
5.Hansen CP, Holtveg H, Francis D. Pulmonary hamartoma. J Thorac Cardiovasc Surg 1992;104:676-8.  Back to cited text no. 5    
6.Wiatrowska BA, Yazdi HM, Matzinger FR, MacDonald LL. Fine needle aspiration biopsy of pulmonary hamartomas. Radiologic, cytologic and immunocytochemical study of 15 cases. Acta Cytol 1995;39:1167-74.  Back to cited text no. 6    
7.Johansson M, Dietrich C, Mandahl N, Hambraeus G, Johansson L, Clausen PP, et al . Recombinations of chromosomal bands 6p21 and 14q 24 characterise pulmonary hamartomas. Br J Cancer 1993;67:1236-40.  Back to cited text no. 7  [PUBMED]  
8.Fletcher JA, Longtine J, Wallace K, Mentzer SJ, Sugarbaker DJ. Cytogenetic and histological findings in 17 pulmonary chondroid hamartomas: evidence for a pathogenetic relationship with lipomas and leiomyomas. Genes Chromosomes Cancer 1995;12:220-3.  Back to cited text no. 8  [PUBMED]  
9.Paulsen JT, Jacobsen M, Francis D. Probable malignant transformation of a pulmonary hamartoma. Thorax 1979;34:557-8.  Back to cited text no. 9    

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Correspondence Address:
S Jacob
Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.40400

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    Figures

  [Figure - 1], [Figure - 2]

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    Abstract
    Introduction
    Case History
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