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Malignant Degeneration of a Pulmonary Hamartoma Into a Pulmonary Chondrosarcoma FREE TO VIEW

Elbert Williams, BS; Jerry Pratt, MD
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Michigan State University College of Human Medicine - Kalamazoo Campus, Kalamazoo, MI

Chest. 2013;144(4_MeetingAbstracts):632A. doi:10.1378/chest.1703647
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SESSION TITLE: Cancer Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Pulmonary hamartomas (PH) have an incidence of 0.25% making them the most common benign tumor of the lung. The potential for malignant degeneration of PH has been controversial. Multiple case reports present PH degenerating into malignant tumors though these have long been disputed.

CASE PRESENTATION: In November of 2012, a 74-year-old woman with a history of a left lower lobe PH was referred for surgery after a CT scan in May revealed tumor enlargement. CT showed a 6.5 x 5.5 cm, irregularly shaped, partially calcified mass in the left lower lobe. Her nodule was first discovered in 1996 and was diagnosed as a chondroid PH after fine needle aspiration (FNA). She was followed with serial CT scans and underwent a repeat FNA in 2004 again demonstrating a chondroid PH. The patient is a former smoker with a 50-pack year history and COPD. In 2003 she underwent lumpectomy and radiation to the right axilla and chest for right-sided breast cancer. At presentation, the patient complained of infrequent cough, fatigue, and myalgia of her upper extremities. She denied any additional respiratory complaints. She was taken to the operating room and the chest was entered through a lateral thoracotomy. The entire left lower lobe was removed. Frozen section revealed adequate margins. She was discharged on post-operative day 4. Pathology revealed a grade 2 chondrosarcoma (CS). There is no evidence of a coexisting or past bone associated tumor.

DISCUSSION: PH are the most common benign tumor of the lung with an incidence of 0.25%. They are typically found in 40-70 year old patients with a 2:1-4:1 predominance in men and are often discovered incidentally. We present a case of malignant degeneration of a chondroid PH. When evaluating a tumor of this nature, it is important to distinguish between a primary CS, a secondary CS, and a malignant PH. It is unlikely our patient had a primary CS due to a longstanding biopsy proven PH. Our patient has no history of a skeletal CS making metastasis unlikely. The authenticity of malignant degeneration of PH has long been called into question. Basile presents a case of malignant degeneration in a patient who underwent resection of a longstanding clinically silent PH. Several months after surgery, the patient expired and a pleomorphic sarcoma was found on necropsy, supporting the ability of PH to undergo malignant change.

CONCLUSIONS: We present a case of malignant degeneration of a PH into a CS. Though rare, our case provides further support to the malignant degenerative potential of PH.

Reference #1: Guo W, Zhao YP, Jiang YG, Wang RW, Ma Z. Surgical treatment and outcome of pulmonary hamartoma: a retrospective study of 20-year experience. J Exp Clin Cancer Res. 2008;27:8.

Reference #2: Steurer S, Huber M, Lintner F. Dedifferentiated chondrosarcoma of the lung: case report and review of the literature. Clin Lung Cancer. 2007;8(7):439-442.

Reference #3: Basile A, Gregoris A, Antoci B, Romanelli M. Malignant change in a benign pulmonary hamartoma. Thorax. 1989;44:232-233.

DISCLOSURE: The following authors have nothing to disclose: Elbert Williams, Jerry Pratt

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