Giant Endobronchial Hamartoma Resulting in Recurrent Post-Obstructive Pneumonias
Ernest G. Chan, Nicholas Baker, Samuel A. Yousem, James D. Luketich, Ryan M. Levy
University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Abstract Pulmonary hamartoma is the most common benign neoplasm of the lung. Roughly 10% of pulmonary hamartomas are located endobronchially. We report a case of a 75-year-old male with a 5-year history of a large right upper lobe endobronchial hamartoma. This resulted in recurrent post-obstructive pneumonias and failure to thrive. The patient was taken to the operating room for bronchoscopic evaluation where a ball-valve type exophytic tumor emanating from the RUL bronchial orifice was identified (Figure 1A). Rigid bronchoscopy with endobronchial debridement was performed, though complete endobronchial resection was not feasible due to the extent of the lesion into the right upper lobe segmental airways. Given the inability to completely resect the lesion via bronchoscopy, surgical resection with right upper lobectomy was recommended. The operative procedure was started with a right video-assisted thoracoscopic approach but was electively converted to a right thoracotomy due to the severe scarring and inflammation, likely a consequence of chronic post-obstructive pneumonia. Tumor was found to be in the parenchyma of the right upper lobe with extension into the bronchus. A bronchotomy was performed at the segmental level which allowed for extraction of the portion of the tumor that was prolapsing into the RUL bronchus. This allowed for standard right upper lobectomy to be performed without need for sleeve resection or pneumonectomy and all intraoperative margins were negative (Figure 1B). Final pathology demonstrated a 4.0 x 3.8 x 2.4 cm endobronchial hamartoma that formed a large polypoid yellow mass with extensive post obstructive bronchiectasis and bronchopneumonia.
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