Asian Cardiovasc Thorac Ann 2000;8:186-188
© 2000 Asia Publishing EXchange Pte Ltd
Mediastinal Hamartoma: Rare Presentation
Sanjeev Sharma, MD,
Anthony P Furnary, MD,
H Storm Floten, MD
Albert Starr Academic Center
Providence St. Vincents Medical Center
Portland, Oregon, USA
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For reprint information contact: Sanjeev Sharma, MD Tel: 1 520 626 6339 Fax: 1 520 626 4042 email: tazsharma{at}aol.com Section of Cardiovascular and Thoracic Surgery, The University of Arizona Health Sciences Center, 1501 N. Campbell Ave, Tucson, AZ 85724-5071, USA.
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Abstract
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Hamartomas are benign mesenchymal tumors that occur most commonly within lung parenchyma. A rare case of mediastinal hamartoma in a 76-year-old man is described. The patient underwent successful excision of the 9.5 x 10.5 x 8-cm mass.
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Introduction
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Mediastinal masses are uncommon and the location of the lesion tends to dictate the histology and prognosis.1,2 Hamartomas are benign tumors that are most often found in the liver and lungs.3,4 Primary mediastinal hamartoma has not been previously reported.
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Case Report
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A 76-year-old man was found to have a large mediastinal mass on routine chest radiography. He reported no chest pain, dyspnea, or dysphagia. A computed tomography scan of the chest revealed an extrapleural 10-cm mass attached to, but not invading, the middle mediastinum on the right side (Figure 1
). Due to the size and location of the mediastinal mass, he underwent a muscle-sparing right thoracotomy. Excision of the mass proceeded without complication and there was no need for excision of lung parenchyma. He was discharged on the 3rd postoperative day. Follow-up 3 years later showed that he was free from local recurrence.
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Figure 1 (A & B). Computed tomography scans revealing a large extrapleural calcified middle mediastinal mass.
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The mass was found to be completely encapsulated and adherent to, but not invading the pericardium. Gross examination revealed a completely encapsulated firm mass measuring 9.5 x 10.5 x 8 cm (Figure 2). The weight of the mass was 238 g. The cut surface had a variegated appearance with areas of white cartilage and areas of focal calcified pink-to-red and pink-to-yellow admixed softer tissue. On sectioning, the tissue was extremely friable and gritty. Microscopy demonstrated predominantly mature cartilage as well as mature fat, connective tissue, smooth muscle, and clefts lined by columnar or cuboidal epithelium that was ciliated in some areas (Figure 2).
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Figure 2. (A) Gross pathology showed a 9.5 x 10.5 x 8-cm firm encapsulated mass. (B) Microscopic pathology revealed cartilaginous hamartoma.
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Discussion
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A hamartoma is a mass of disorganized but mature cells or tissue indigenous to the particular site.5 It can be found in the liver but it occurs most commonly within the lung parenchyma.4,6 Pulmonary hamartomas account for approximately 8% of pulmonary neoplasms.6 They are predominantly asymptomatic and small (mean size, 1.5 cm). These are benign tumors with a peak incidence of occurrence in the seventh decade of life and they are more common in males.7,8 Pulmonary hamartomas are not encapsulated, they are slow growing, and are rarely malignant.2 Their relevance is in differentiating them from malignant masses. Radiologic examination usually reveals a circumscribed lesion with calcification. However, carcinomas and tuberculosis may also have calcification within the lesion. Needle aspiration may be appropriate in determining the diagnosis.
Davis and colleagues1 reported 300 mediastinal masses treated by surgical excision at Duke University Medical Center from 1930 to 1986. The majority (54%) of lesions occurred in the anterosuperior mediastinum, 26% were in the posterior mediastinum, and 20% were in the middle mediastinum. Benign cysts accounted for 60% of the middle mediastinal masses. The presence of symptoms (chest pain, dyspnea, cough) was a predictor of malignant potential of these mediastinal mass. Overall, symptoms were present in 85% of patients with malignant masses compared with 46% of those with benign tumors.
Our patient presented with a large asymptomatic extra-pulmonary mediastinal mass. The etiology must have been mesenchymal, either from pleural or pericardial mesothelial cells, or from the diaphragm, because of the mature cartilage that predominated within the mass. We are not aware of any case of primary mediastinal hamartoma that has previously been reported in the literature.
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References
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Hansen CP, Holtveg H, Francis D, Rasch L, Bertersen S. Pulmonary hamartoma. J Thorac Cardiovasc Surg 1992;104:674–8.[Abstract]
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DeMaioribus CA, Lally KP, Sim K, Isaacs H, Mahour GH. Mesenchymal hamartoma of the liver. Arch Surg 1990;125:598–600.[Abstract/Free Full Text]
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Rosai J, editor. Ackerman's surgical pathology. 8th ed. St. Louis: Mosby Year Book, 1996:391–2.
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Abstract
Introduction
