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Pulmonary chondroid hamartoma with nontuberculous mycobacterial infection: two case reports.

Lee YC, Moon JC, Gang SJ, Park SY, Kim SR - Medicine (Baltimore) (2015)

Bottom Line: Interestingly, the diagnostic workup revealed that the patient had Lady Windermere syndrome which is one of features for Mycobacterium avium complex (MAC) pulmonary disease.Both patients were treated with the standard antibiotics against MAC as recommended by the ATS/IDSA guideline.This is the first report of 2 patients, as far as we know, that chondroid hamartoma and NTM disease develop simultaneously in the lung.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Internal Medicine and Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonju, South Korea.

ABSTRACT
Solitary pulmonary nodules (SPNs) can be manifested in a variety of disorders including neoplasms, infection, inflammation, and vascular or congenital abnormalities. In addition, they are often accompanied with other pulmonary pathologic lesions such as consolidations and several pulmonary disorders present as similar pulmonary nodular lesions simultaneously. Diagnostic workup is important for these SPNs; however, many physicians often miss the second diagnosis for multiple pulmonary lesions with SPNs due to lack of clinical suspicion that each pulmonary nodule or pathologic lesion can have each other's diagnosis. Herein, we report 2 cases of coexistence of pulmonary chondroid hamartoma with nontuberculous mycobacterial (NTM) infection presenting as pulmonary nodules and multiple consolidative lesions. A 60-year-old man was admitted for the evaluation of multifocal pulmonary lesions including SPN with chronic exertional dyspnea. Multiple lung tissues were obtained from each lesion through percutaneous transthoracic needle biopsy (PTNB). At the same time, bacteriologic examination was performed using respiratory samples obtained by bronchoscopy. Based on pathologic and microbiologic results, the patient diagnosed as pulmonary chondroid hamartoma with pulmonary NTM infectious disease. In addition, a 56-year-old woman visited for the evaluation of a small SPN. The SPN was resected surgically for the pathologic examination and turned out to be pulmonary chondroid hamartoma. Interestingly, the diagnostic workup revealed that the patient had Lady Windermere syndrome which is one of features for Mycobacterium avium complex (MAC) pulmonary disease. Both patients were treated with the standard antibiotics against MAC as recommended by the ATS/IDSA guideline. This is the first report of 2 patients, as far as we know, that chondroid hamartoma and NTM disease develop simultaneously in the lung. This report emphasizes that physicians should endeavor to confirm the individual diagnosis for the various pulmonary abnormal lesions detected at the same time, if necessary through multifocal biopsies for each lesion.

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Microscopic features of chondroid hamartoma of the lung. (A) Tumor component is identified within the normal lung alveolar structures (H&E stain, ×40). (B) Most of the tumor was composed of proliferating connective tissue. Mature cartilaginous tissue was also identified (right lower side) (H&E stain, ×100). H&E = Hematoxylin & Eosin.
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Figure 4: Microscopic features of chondroid hamartoma of the lung. (A) Tumor component is identified within the normal lung alveolar structures (H&E stain, ×40). (B) Most of the tumor was composed of proliferating connective tissue. Mature cartilaginous tissue was also identified (right lower side) (H&E stain, ×100). H&E = Hematoxylin & Eosin.

Mentions: A 56-year-old woman visited our clinic due to an SPN detected incidentally in high-resolution computed tomography (HRCT) during routine medical checkup. A month ago, she had been diagnosed with pneumonia and treated with an empirical antibiotic regimen of cefpodoxime and roxithromycin. She had completely recovered after the oral antibiotic therapy. Later, she was notified that M. avium was identified in sputum expectorated during the diagnostic workup. At the visiting time for the evaluation of SPN, she had no respiratory symptoms and complaints. HRCT revealed that her radiologic findings were focal bronchiectatic change with consolidations in the right middle lobe and left lingular segment as well as an SPN in the right lower lobe (Figure 3). First of all, to diagnose the SPN histologically, the SPN was resected surgically from the right lower lobe and the pathologic diagnosis of the SPN was chondroid hamartoma (Figure 4), while the patient also underwent the bronchoscopy to obtain the respiratory specimens and the repeated sputum examinations for the diagnosis of pulmonary NTM according to the ATS/IDSA guideline for NTM.5 The microbiological examination revealed that M. avium was identified again in bronchial washing fluids obtained from the patient. Finally, the workup for her radiologic abnormalities confirmed coexistence of pulmonary chondroid hamartoma with NTM infection. Therefore, she started to take the medication for NTM infection with rifampin (600 mg/day), ethambutol (1000 mg/day), and clarithromycin (1000 mg/day) on a daily basis. According to the ATS/IDSA guideline, the treatment with this regimen was planned to keep till at least 12 months after the negative conversion of NTM on microbiological examination. She had no complications at 12 months follow-up.


Pulmonary chondroid hamartoma with nontuberculous mycobacterial infection: two case reports.

Lee YC, Moon JC, Gang SJ, Park SY, Kim SR - Medicine (Baltimore) (2015)

Microscopic features of chondroid hamartoma of the lung. (A) Tumor component is identified within the normal lung alveolar structures (H&E stain, ×40). (B) Most of the tumor was composed of proliferating connective tissue. Mature cartilaginous tissue was also identified (right lower side) (H&E stain, ×100). H&E = Hematoxylin & Eosin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554048&req=5

Figure 4: Microscopic features of chondroid hamartoma of the lung. (A) Tumor component is identified within the normal lung alveolar structures (H&E stain, ×40). (B) Most of the tumor was composed of proliferating connective tissue. Mature cartilaginous tissue was also identified (right lower side) (H&E stain, ×100). H&E = Hematoxylin & Eosin.
Mentions: A 56-year-old woman visited our clinic due to an SPN detected incidentally in high-resolution computed tomography (HRCT) during routine medical checkup. A month ago, she had been diagnosed with pneumonia and treated with an empirical antibiotic regimen of cefpodoxime and roxithromycin. She had completely recovered after the oral antibiotic therapy. Later, she was notified that M. avium was identified in sputum expectorated during the diagnostic workup. At the visiting time for the evaluation of SPN, she had no respiratory symptoms and complaints. HRCT revealed that her radiologic findings were focal bronchiectatic change with consolidations in the right middle lobe and left lingular segment as well as an SPN in the right lower lobe (Figure 3). First of all, to diagnose the SPN histologically, the SPN was resected surgically from the right lower lobe and the pathologic diagnosis of the SPN was chondroid hamartoma (Figure 4), while the patient also underwent the bronchoscopy to obtain the respiratory specimens and the repeated sputum examinations for the diagnosis of pulmonary NTM according to the ATS/IDSA guideline for NTM.5 The microbiological examination revealed that M. avium was identified again in bronchial washing fluids obtained from the patient. Finally, the workup for her radiologic abnormalities confirmed coexistence of pulmonary chondroid hamartoma with NTM infection. Therefore, she started to take the medication for NTM infection with rifampin (600 mg/day), ethambutol (1000 mg/day), and clarithromycin (1000 mg/day) on a daily basis. According to the ATS/IDSA guideline, the treatment with this regimen was planned to keep till at least 12 months after the negative conversion of NTM on microbiological examination. She had no complications at 12 months follow-up.

Bottom Line: Interestingly, the diagnostic workup revealed that the patient had Lady Windermere syndrome which is one of features for Mycobacterium avium complex (MAC) pulmonary disease.Both patients were treated with the standard antibiotics against MAC as recommended by the ATS/IDSA guideline.This is the first report of 2 patients, as far as we know, that chondroid hamartoma and NTM disease develop simultaneously in the lung.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Internal Medicine and Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonju, South Korea.

ABSTRACT
Solitary pulmonary nodules (SPNs) can be manifested in a variety of disorders including neoplasms, infection, inflammation, and vascular or congenital abnormalities. In addition, they are often accompanied with other pulmonary pathologic lesions such as consolidations and several pulmonary disorders present as similar pulmonary nodular lesions simultaneously. Diagnostic workup is important for these SPNs; however, many physicians often miss the second diagnosis for multiple pulmonary lesions with SPNs due to lack of clinical suspicion that each pulmonary nodule or pathologic lesion can have each other's diagnosis. Herein, we report 2 cases of coexistence of pulmonary chondroid hamartoma with nontuberculous mycobacterial (NTM) infection presenting as pulmonary nodules and multiple consolidative lesions. A 60-year-old man was admitted for the evaluation of multifocal pulmonary lesions including SPN with chronic exertional dyspnea. Multiple lung tissues were obtained from each lesion through percutaneous transthoracic needle biopsy (PTNB). At the same time, bacteriologic examination was performed using respiratory samples obtained by bronchoscopy. Based on pathologic and microbiologic results, the patient diagnosed as pulmonary chondroid hamartoma with pulmonary NTM infectious disease. In addition, a 56-year-old woman visited for the evaluation of a small SPN. The SPN was resected surgically for the pathologic examination and turned out to be pulmonary chondroid hamartoma. Interestingly, the diagnostic workup revealed that the patient had Lady Windermere syndrome which is one of features for Mycobacterium avium complex (MAC) pulmonary disease. Both patients were treated with the standard antibiotics against MAC as recommended by the ATS/IDSA guideline. This is the first report of 2 patients, as far as we know, that chondroid hamartoma and NTM disease develop simultaneously in the lung. This report emphasizes that physicians should endeavor to confirm the individual diagnosis for the various pulmonary abnormal lesions detected at the same time, if necessary through multifocal biopsies for each lesion.

Show MeSH
Related in: MedlinePlus