Pulmoner Hamartom; Klinik, Radyolojik ve Patolojik Özellikleri Eşliğinde 10 Yıllık Hastane Deneyimimiz

Öz

Amaç: Akciğerin benign lezyonu olan pulmoner hamartom nadir bir lezyondur ve soliter pulmoner nodüllerin %6’sını oluşturur. Çalışmada, hastanemizde tanı alan, 10 pulmoner hamartom olgusunun klinik, radyolojik ve patolojik özellikleri incelenmiştir. Gereç ve Yöntemler: Ocak 2006 ile Aralık 2016 tarihleri arasında hastane dosya arşivi ve bilgisayar verileri retrospektif olarak incelendi.Bulgular: Olguların yaş ortalaması 52,3 yıl 33-67yıl olup, altı olgu kadın, dört olgu erkekti. Yedi olgu semptomatik olup bir olguya eş zamanlı akciğer adenoskuamöz karsinomu eşlik etmekte idi. Lezyonların çoğunluğu %60 sol akciğerde yerleşimli ve ortalama çapı 3,12 cm 1-6 cm idi. Tüm olgular periferik yerleşimliydi. Yalnızca bir olguda %16,6 popcorn kalsifikasyon izlendi. Tüm olgulara wedge rezeksiyon ve kitle enükleasyonu içeren akciğeri koruyucu cerrahi uygulandı. Eksizyon sonrası, ortalama 36,23 ay 25 gün-113 ay takip süresi boyunca nüks veya malignite gelişimi izlenmedi ve pulmoner hamartom nedenli ölüm olmadı.Sonuç: Akciğer kanseri ayırıcı tanısı nedeniyle pulmoner hamartom önemlidir. Radyolojik olarak ancak %34-50 oranında tanı verilebildiği için multidisipliner davranmanın gerekli olduğu, klinik ve radyolojik bulgular eşliğinde ince iğne aspirasyon veya tru-cut biyopsi kullanılarak tanı konulabileceği ve cerrahi uygulanmaksızın güvenle takip edilebileceği unutulmamalıdır. Cerrahi sonrası ise takip gerekli değildir

Anahtar Kelimeler

• Pulmoner hamartom, Popcorn kalsifikasyon, Akciğer tümörleri, Soliter Pulmoner Nodül, Benign akciğer tümörleri

Pulmonary Hamartoma; 10 Years of Hospital Experience with the Clinical, Radiological and Pathological Features

Abstract

Objective: A benign lesion of the lungs, pulmonary hamartoma is a rare lesion and makes up 6% of the solitary pulmonary nodules. In the present study, we aimed to examine the clinical, radiological, and pathological characteristics of 10 pulmonary hamartoma cases diagnosed at our hospital. Material and Methods: The hospital file archive and computer data between January 2006 and December 2016 were evaluated retrospectively. Results: The mean age of the cases was 52.3 years 33-67 years old ; and 6 cases were female whereas 4 cases were male. 2 cases were symptomatic and 1 case had accompanying adenosquamous carcinoma of the lung. The majority of the lesions 60% were located in the left lung with an average diameter of 3.12 cm 1-6 cm . All cases were peripherally located. Popcorn calcification was observed only in 1 case 16.6% . Protective lung surgery including wedge resection and mass enucleation was performed in all cases. No recurrences or malignancy development was observed, and no death caused by pulmonary hamartoma was encountered in the course of the average monitoring period of 36.23 months 25 days–113 months following excision. Conclusion: Pulmonary hamartoma is important because of the differential diagnosis of lung cancer. Since the diagnosis can only be made at a rate of 34-50% via radiology, it is necessary to approach the case in a multidisciplinary manner. The diagnosis can be made with the clinical and radiological findings accompanying fine needle aspiration or tru-cut biopsy, and the disease can be safely monitored without any surgical intervention. No follow-up procedure is necessary following the surgery

Keywords

• Pulmonary hamartoma, Popcorn calcification, Lung tumors, Solitary Pulmonary Nodule, Benign lung tumors

Kaynakça

1. Gjevre J, Myers J, Prakash U. Pulmonary hamartomas. Mayo Clin Proc 1996;71:14–20.
2. Toomes H, Delphendahl A, Manke HG, Vogt-Moykopf I. The coin lesion of the lung. A review of 955 resected coin lesions. Cancer 1983;51:534-7.
3. Khan AN, Al-Jahdali HH, Allen CM, Irion KL, Al Ghanem S, Koteyar SS. The calcified lung nodule: What does it mean? Ann Thorac Med 2010;5:67-79.
4. Pollock AB, Al Hasan M, Roy TM, Byrd RP. Pulmonary Hamartoma: An Algorithmic approach to the diagnosis and management. Clin Pulm Med 2008;15:35-9.
5. Abdulhamid I, Rabah R. Endobronchial chondromatous hamartoma in an infant. Pediatr Pulmonol 2003;35:67-9.
6. Saadi MM, Barakeh DH, Husain S, Hajjar WM. Large multicystic pulmonary chondroid hamartoma in a child presenting as pneumothorax. Saudi Med J 2015;36:487-9.
7. Salminen US. Pulmonary hamartoma. A clinical study of 77 cases in a 21-year period and review of literature. Eur J Cardiothorac Surg 1990;4:15-8.
8. Guo W, Zhao YP, Jiang YG, Wang RW, Ma Z. Surgical treatment and outcome of pulmonary hamartoma: A ret- rospective study of 20-year experience. J Exp Clin Cancer Res 2008;31;27-8.

9. Van den Bosch JM, Wagenaar SS, Corrin B, Elbers JR, Knaepen PJ, Westermann CJ. Mesenchymoma of the lung (so called hamartoma): A review of 154 parenchymal and endobronchial cases. Thorax 1987;42:790-3.
10. Von Ahsen I, Rogalla P, Bullerdiek J. Expression patterns of the LPP-HMGA2 fusion transcript in pulmonary chondroid hamartomas with t(3;12)(q27 approximately 28;q14 approximately 15). Cancer Genet Cytogenet 2005;163:68-70.
11. Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB, Chirieac LR, Dacic S, Duhig E, Flieder DB, Geisinger K, Hirsch FR, Ishikawa Y, Kerr KM, Noguchi M, Pelosi G, Powell CA, Tsao MS, Wistuba I. The 2015 World Health Organization Classification of Lung Tumors Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol 2015;10:1243-60.
12. Wang T, Liu Y. Outcomes of surgical treatments of pulmonary hamartoma. J Cancer Res Ther Suppl 2016;12:116-9.
13. Jhun BW, Lee KJ, Jeon K, Um SW, Suh GY, Chung MP, Kwon OJ, Kim H. The clinical, radiological, and bronchoscopic findings and outcomes in patients with benign tracheobronchial tumors. Yonsei Med J 2014;55:84-91.
14. Madan K, Sharma S, Singh N, Radhika S. Large pulmonary hamartoma with “popcorn” like calcification. Monaldi Arch Chest Dis 2011; 75:243-4.
15. Wiatrowska BA, Yazdi HM, Matzinger FRK, MacDon- ald LL. Fine-needle aspiration biopsy of pulmonary ham- artomas. Radiologic, cytologic and immunocytochemical study of 15 cases. Acta Cytologica 1995;39:1167-74.
16. Hughes JH, Young NA, Wilbur DC, Renshaw AA, Mody DR. Fine-needle aspiration of pulmonary hamartoma: A common source of false-positive diagnoses in the College of American Pathologists Inter laboratory comparison program in nongynecologic cytology. Arch Pathol Lab Med 2005;129:19-22.
17. Hansen CP, Holtveg H, Francis D, Rasch L, Bertelsen S. Pulmonary hamartoma. J Thorac Cardiovasc Surg 1992;104:674-8.
18. Dutta R, Kumar A, Tanveer N, Jindal T, Khilnani GC. Endobronchial fibroleiomyomatous hamartoma: A diagnostic pitfall. Gen Thorac Cardiovasc Surg 2010; 58:352-5.
19. Sinner WN. Fine needle biopsy of hamartomas of the lung. Am J Roentgenol 1982;138:65-9.
20. Laroche C, Stewart S, Wells F, Shneerson J. Multiple recurrent mesenchymomas (hamartomas). Thorax 1993;48:572-3.
21. Karasik A, Modan M, Jacob CO, Lieberman Y. Increased risk of lung cancer in patients with chondromatous hamartoma. J Thorac Cardiovasc Surg 1980;80:217-20.
22. Lee BJ, Kim HR, Cheon GJ, Koh JS, Kim CH, Lee JC. Squamous cell carcinoma arising from pulmonary hamartoma. Clin Nucl Med 2011;36:130-1.
23. Minami Y, Iijima T, Yamamoto T, Morishita Y, Terashima H, Onizuka M, Noguchi M. Diffuse pulmonary hamartoma: A case report. Pathol Res Pract 2005; 200:813-6.