Pulmonary Hamartomas: A Single-Center Analysis of 59 Cases

Abstract

Objective: This study investigated the clinical, radiological, and surgical treatment results of patients who underwent surgical treatment for pulmonary hamartomas. Materials and Methods: Fifty-nine consecutive patients who underwent surgical treatment for pulmonary hamartomas in our clinic between January 2001 and February 2021 were analyzed retrospectively. Results: Forty-three out of 59 (72.9%) of the cases were male and 16 (27.1%) were female. The average age was 52.0 ± 15.0 (between 5 years and 80 years). While pulmonary hamartoma was in the form of a solitary pulmonary nodule in 55 (93.2%) of the cases, there were multiple lesions in 4 (6.8%) cases. Simultaneous gastric adenocarcinoma was detected in 1 patient. One case had been operated on for Wilms tumor. Twenty-two (37.3%) of the cases were asymptomatic and were detected incidentally. Locations of pulmonary hamartomas were 18 (29.0%) in the left lower lobe, 16 (25.8%) in the right upper lobe, 12 (19.4%) in the right lower lobe, 9 (14.5%) in the left upper lobe, and 7 (11.3%) in the right middle lobe. The mean lesion diameter was 22.0 ± 9.5 mm (between 10 mm and 56 mm). Mild to moderate fluorodeoxyglucose (FDG) uptake was observed in 11 of 15 cases that were evaluated with positron emission tomography/computed tomography. Surgically, 44 (74.6%) patients underwent wedge resection, 13 (22.0%) patients underwent enucleation and two (3.4%) patients underwent lobectomy. Perioperative morbidity and mortality were not observed in any of the cases. The cases were followed up for an average of 40.6 ± 38.7 months (between 1 month and 151 months). No recurrence was observed in any of the cases during follow-up. Conclusion: Pulmonary hamartomas are usually detected incidentally and as a solitary pulmonary nodule. Although radiological findings provide important information, a definitive diagnosis is usually made during surgery. Parenchyma-sparing surgery should be preferred in these cases whenever possible.

The clinicopathological challenges of symptomatic and incidental pulmonary hamartomas diagnosis

“…Although, PHs can develop in any lung lobe, they are more frequently observed in the right lower lobe [15]. In our study, in agreement with literature data, 40.74% of nodular lesions were located in the right upper lobe and only 7.4% of them in the left upper lobe.…”

“…Recent data are suggesting that there is an association between PHs and lung or other extrapulmonary neoplasms [12,15]. In this regard, 29.3% rate of malignancies (most frequently lung cancer) were detected in a series of 215 patients with PHs [16].…”

“…The conventional PHs treatment is usually the surgical resection [15]. This method is especially recommended in symptomatic patients, in PHs lesions larger than 2.5 cm or when malignancy cannot be excluded [11,15].…”

“…Additionally, the rearrangement of 12q14-q15, involving the high mobility group AT-hook 2 (HMGA2) gene, can be detected in approximately 80% of patients [ 13 , 14 ]. Recent data are suggesting that there is an association between PHs and lung or other extrapulmonary neoplasms [ 12 , 15 ]. In this regard, 29.3% rate of malignancies (most frequently lung cancer) were detected in a series of 215 patients with PHs [ 16 ].…”

“…However, large PHs are also described in literature, e.g., a PH of 28×18×17 cm and 2.1 kg weight, diagnosed in a 39-year-old man [ 21 ]. Although, PHs can develop in any lung lobe, they are more frequently observed in the right lower lobe [ 15 ]. In our study, in agreement with literature data, 40.74% of nodular lesions were located in the right upper lobe and only 7.4% of them in the left upper lobe.…”