P-199A UNIQUE CASE OF A GIANT HAMARTOMA GROWING ENDOLUMINALLY FROM A HUGELY ECTASIC SEGMENTAL BRONCHUS

• Published in: Interactive cardiovascular and thoracic surgery 2014-06, Vol.18 (suppl_1), p.S52-S52
• Main Authors: Bilancia, Rocco, Hernandez-Arenas, L., Internullo, E.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu167.199

Objectives: To describe the case of a man with a lung mass, growing endobronchially as a long polypoid lesion from a hugely ectasic segment-6 bronchus up to the carina. Case description: A 61-year-old male, ex-smoker with unremarkable past history, complained of dry distressing cough and increasing breathlessness for the previous 3 years, unsuccessfully treated as asthma. CT-scan outlined a cavitation of the right lower lobe segment-6 containing a solid, non-calcific, 45 mm mass. An endobronchial lesion occupying the bronchus intermedius up to the carina was also seen. Radiologists hypothesized the endobronchial lesion to have caused post-obstructive phenomena leading to cavitation and fungus ball. At bronchoscopy, an endobronchial cherry-red elongated polyp was partially obstructing the right main bronchus and could be easily passed over and followed until middle lobe bronchus take-off; no clear pedicle was seen. Endobronchial biopsies showed only normal bronchial mucosa. PET-scan was negative. Due to symptoms, size, uncertain diagnosis and endoluminal extension, surgical indication was given. Thoracotomy was performed. Right lower bronchus was cut open: the endobronchial polyp was easily retrieved from within the proxymal bronchial tree, whilst distally it showed to be surprisingly continuing with the main solid, hard-at-touch segment-6 mass, growing in a hugely ectasic segmental bronchus. Lower lobectomy was therefore completed. At macroscopic examination the total length of the lesion - including its endobronchial extension - was 76 mm. The final diagnosis on the whole specimen was benign chondroid hamartoma. The patient was discharged without complications after 5 days. Symptoms permanently disappeared after the operation. Conclusions: No case has ever been recorded of a giant pulmonary hamartoma growing in an ectasic segmental bronchus in addition with such proximal intrabronchial growth. Management of complex endobronchial masses is challenging and thoughtful intraoperative assessment is key. Disclosure: No significant relationships.