Hamartomas are the most common benign pulmonary neoplasms, and approximately 90 percent of them are located within parenchyma. Tracheal hamartomas are extremely rare, and only nine cases had been found in the available literature. Rarely, hamartomas are multiple, and most of these are the fibroleiomyomatous type occurring in female subjects. We report a rare case of a man with a pulmonary chondroid hamartoma accompanied by a similar endotracheal lesion. We discuss the relationship between parenchymal and endotracheal tumors and further speculate on the pathogenesis of hamartoma.
A 70-year-old Japanese asymptomatic man was referred to our hospital after a routine chest radiograph showed a well-demarcated nodule behind the heart (Fig 1). The patient had an 18 pack-year smoking history but a medical history that disclosed no abnormalities. Vital signs and laboratory data were essentially normal. The patient’s previous roentgenograms showed, in retrospect, the lesion to have been present for 6 years and to have slightly increased in size. Computed tomography showed a 4X3.5-cm mass of heterogenous density with speckled calcification in the left lower lobe without obvious involvement of adjacent structures fully.
Examination with a bronchofiberscope revealed, incidentally, a yellowish small polypoid tumor at the cartilaginous ring of the trachea (Fig 2). The biopsy specimen of the tumor demonstrated cartilage tissue and loose myxomatous tissue covered with bronchial epithelium. The tumor was histologically diagnosed as a chondroid hamartoma.
Transbronchial biopsies of the tumor in the left lower lobe were nondiagnostic. Despite the clinical diagnosis of a benign lung tumor, because of a concern about malignancy due to the growth in size over time and the patient’s own desire for a definitive diagnosis, surgery was performed.
Figure 1. Chest x-ray film showing a well-circumscribed nodular shadow behind the heart.
Figure 2. Bronchoscopic view of a tracheal nodule.