Advertisement

Popcorn in the Lung

      A 65-year-old man was admitted for breathlessness and dry cough of 3-month duration. He denied any history of cigarette smoking and asbestos exposure. The patient's physical examination revealed reduced breath sounds over middle-upper right hemithorax. The patient's laboratory data and vital signs were normal. A posteroanterior chest radiograph showed a large and well circumscribed pulmonary mass on the right side (Fig. 1). Computed tomography scan confirmed a large, solitary, well delimited, round, inhomogeneous, mass of 12 × 8 × 15 mm in size in the right upper lobe, with calcifications of a linear, nodular, irregular shape (Fig. 2). There was no mediastinal or hilar lymphadenopathy. The radiological findings were highly suggestive of a giant pulmonary chondroid hamartoma. Through a muscle sparing lateral thoracotomy, a right upper lobectomy was performed. Histologic examination yielded a well circumscribed hamartoma with predominantly benign chondroid differentiation. The patient was discharged 5 days after surgery. Pulmonary hamartomas are the most common form of benign lung tumors, derived from the peribronchial mesenchyma. The prevalence varies from 0.025% to 0.32% according to different necropsy studies. They are more common in males with a peak incidence in the sixth or seventh decade of life. Pulmonary hamartomas can be divided into parenchymal (90%) and endobronchial (10%) and can be chondromatous or leiomyomatous or a combination thereof.
      • Ganti S
      • Milton R
      • Davidson L
      • Anikin V
      Giant pulmonary hamartoma.
      The parenchymal lesions are usually an incidental radiological finding of a round opacity in the periphery of the lung. The presence of calcifications typically dispersed in the form of multiple clumps throughout the lesion in a popcorn configuration can be found in 10–15% of pulmonary hamartomas on chest radiographs.
      • Madan K
      • Sharma S
      • Singh N
      • Radhika S
      Large pulmonary hamartoma with “popcorn” like calcification.
      Pulmonary chondroid hamartomas measuring over 10 cm are very rare.
      • Ganti S
      • Milton R
      • Davidson L
      • Anikin V
      Giant pulmonary hamartoma.
      Lobectomy is the operation of choice when a giant tumor causes complete replacement of the lobe as in our case.
      Figure thumbnail gr1
      FIGURE 1Posteroanterior chest radiograph detecting a large and well circumscribed pulmonary mass on the right side with diffuse calcifications.
      Figure thumbnail gr2
      FIGURE 2Chest computed tomography scan revealing, in the right upper lobe, a large, solitary, and inhomogeneous mass with “popcorn” calcification.

      REFERENCES

        • Ganti S
        • Milton R
        • Davidson L
        • Anikin V
        Giant pulmonary hamartoma.
        J Cardiothorac Surg. 2006; 1: 19
        • Madan K
        • Sharma S
        • Singh N
        • Radhika S
        Large pulmonary hamartoma with “popcorn” like calcification.
        Monaldi Arch Chest Dis. 2011; 75: 243-244