Large multicystic pulmonary chondroid hamartoma in a child presenting as pneumothorax

Abstract

We describe a 10-year-old boy with a rare large multicystic pulmonary chondroid hamartoma in the right lower lobe presenting with severe respiratory distress. The radiological evaluation showed a large multicystic lesion in the right lower lobe with pneumothorax. Commonly, pulmonary hamartomas are asymptomatic, small in size, and are diagnosed incidentally in adults. Our case is highly unusual due to its young age, prominent clinical symptoms of severe respiratory distress with pneumothorax at presentation, very large size, and prominent cystic change. The lesion was surgically excised, and histopathological features were compatible with a multicystic chondroid hamartoma.

Figure 1

Computed tomography scan of the multicystic pulmonary hamartoma showing: A) Axial cut demonstrates a large multiseptate cystic lesion in the right hemithorax (arrow), some of the cysts are air filled while others are fluid filled. This lesion shows mass effect upon adjacent mediastinum. B) Coronal image shows the multilocular nature of this cystic lesion (arrow), and its effect upon the adjacent lung tissue and the pneumothorax.

Figure 2

Photomicrograph of the multicystic pulmonary hamartoma showing: A) A mass composed of numerous microcystic spaces (arrow) with multiple micronodules (arrowhead) in the wall of the microcysts. (Hematoxylin and Eosin stain; original magnification ×20). B) The micronodules are lined by benign flattened to cuboidal epithelial cells. The micronodules are composed of hyaline cartilage (arrow), fibrous tissue, and adipose tissue (arrowhead). There is no pleomorphism, abnormal mitosis or necrosis in the any of the cartilaginous, fibrous, or adipocytic mesenchymal elements (Hematoxylin and Eosin stain; original magnification ×40).