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Objectives This study aimed to evaluate 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) findings in the differential diagnosis of pulmonary carcinoids and pulmonary hamartomas. Methods 18F-FDG PET/CT findings of 34 patients with pulmonary carcinoids (12 atypical, 22 typical) and 32 patients with pulmonary hamartomas were retrospectively evaluated. Both mean diameter and mean maximum standardized uptake value (SUVmax) of hamartomas and carcinoids were compared by Mann-Whitney U and Kruskall-Wallis H tests. Results The mean longest diameter of atypical carcinoids (3.5±1.7 cm) was higher than that of hamartomas (2.1±1 cm) (p=0.038). No significant difference was found between the mean diameter of typical carcinoids and mean diameter of hamartomas (p=0.128). The mean SUVmax of atypical carcinoids (5.97±3.7) and typical carcinoids (4.22±1.7) were higher than those of hamartomas (1.65±0.9) (p=0.002 and p=0.003, respectively). There were collapse/consolidation in 55.8%, bronchiectasis or mucoid impaction in 47%, and air trapping in 14.7% in the peripheral parenchyma of the 34 carcinoids. Collapse/consolidation was detected in a patient with endobronchial hamartoma, and other finding was not found in the parenchyma around hamartomas. Conclusion The 18F-FDG uptake of pulmonary carcinoids can vary from minimal to intense. 18F-FDG uptake can be seen in pulmonary hamartomas. However, the mean SUVmax of atypical carcinoids and typical carcinoids were higher compared to hamartomas. Pulmonary carcinoid must be suspected in cases with accompanying bronchial obstruction findings in the periphery of the mass.

Introduction Recently, treatment of endobronchial hamartomas with interventional bronchoscopic methods has become possible. Although there are several reports of therapeutic benefits, the protocol of administration varies between centers and high recurrence rates continue to be a problem. In this study, we aimed to show that cryotherapy applied to the root of the bronchial wall after removal of the intraluminal portion of endobronchial hamartoma with interventional bronchoscopic methods can prevent recurrences. Materials and Methods Between 2012-2016, the treatment outcomes and long-term follow-up data of patients with symptomatic endobronchial hamartomas treated by interventional bronchoscopic methods were prospectively recorded. After debulking, cryotherapy was applied to the root of the bronchial wall of all lesions. The data were analyzed retrospectively. Result A total of 21 consecutive patients were studied. Twenty (95.2%) of the patients underwent complete resection and only 1 (4.8%) had incomplete resection with various interventional bronchoscopy techniques. One (4.8%) patient who underwent incomplete resection and ineffective cryotherapy relapsed. The other 20 (95.2%) patients were followed up periodically for an average of 36.0 ± 15.0 months. No recurrence was detected. No complications or deaths related to the procedure were observed. Conclusions Debulking of endobronchial hamartomas with interventional bronchoscopic methods is effective and safe. Cryotherapy to the root of the lesion may prevent high recurrence rates.

Airway hamartomas are of mesenchymal tissue origin and have predominance of adipose tissue. Hamartoma refers to a tumour-like structure within an organ composed of an abnormal arrangement of tissue components normally found in that organ. The pulmonary parenchyma and airways are commonly described sites for this lesion, although endobronchial location is far less common than its parenchymal counterpart. When present within a major airway, the usual symptoms of an airway lesion like cough, wheezing, stridor, haemoptysis and postobstructive consolidation ensue. We describe the case of a 60-year-old gentleman who presented with cough of 9 months duration. On evaluation he was found to have an endobronchial lesion in the right main bronchus. The histopathology revealed features of endobronchial hamartoma which was then subjected to endobronchial intervention with electrocautery and cryoablation achieving complete removal and restoration of luminal patency. This case underscores the ability of endobronchial treatment modalities to successfully treat benign airway lesions like hamartoma when undertaken in experienced centres.

Pneumonia is an infection of the lungs that can result from various etiologies, including bronchial obstruction. It is estimated that 5.4% of community-acquired pneumonia occurs as a result of an endobronchial obstruction, classifying them as post-obstructive pneumonia. Pulmonary hamartomas are benign and exceedingly rare tumors. These hamartomas are usually asymptomatic and found incidentally on imaging, however, they can cause patients to develop post-obstructive pneumonia. We present a 40-year-old female with cough, fatigue, and recurrent right lower lobe pneumonia. Upon workup with bronchoscopy and biopsy, she was subsequently found to have an endobronchial hamartoma resulting in recurrent pneumonia in the same location. We are happy to report that the patient had a resection of the mass, as well as of the affected lung lobe, and has been pneumonia-free for five months. We hope to encourage a greater index of suspicion for endobronchial masses, including rare tumors, when a patient presents with recurrent pneumonia in the same location.

To evaluate the clinical characteristics, efficacy and safety of flexible endoscopic intervention for endobronchial hamartoma.Thirteen patients with endobronchial hamartoma who underwent flexible endoscopic intervention at a single center were analyzed retrospectively. The clinical characteristics and efficacy of flexible endoscopic intervention were described.Nine patients were cured after one single flexible endoscopic intervention, three patients underwent second flexible endoscopic interventions due to late tumor recurrence, while one patient who eventually became stable with a 40% stenosis of the airway lumen, received a third intervention because of two relapses. Pneumothorax occurred in one patient who was cured after oxygen therapy. There were no serious complications such as massive hemorrhage, airway perforation, airway ignition and suffocation associated with the therapy.Flexible endoscopic intervention appeared to be safe and effective for the treatment of patients with endobronchial hamartoma.

Objective: Exploration for chronic obstructive pulmonary disease with branched air lumen hamartoma by bronchoscoptic treatment. Material and Method: An old man was referred to our hospital with shortness of breath for many years. Clinical evidence emphysema on respiratory examination, lung function and chest X-ray gave rise to concern. He was diagnosed as COPD and treated with ICS + LABA. But the shortness of breath is still existed. Initial assessment by CT suggested a left lower lobe collapse. Then bronchoscope identified a solid abnormality in main left bronchus. The pathology showed a benign neoplasm. Because of intolerance of operation, the patient was treated by brochoscopic intervention. The endoscopic intervention included resection by electrosurgical snare, electrocautery, argon plasma coagulation (APC). Result: After intervention, the neoplasm was partly removed and the pathological result was endobrochial hematoma. After treatment, the patient’s panting had taken a turn for the better. After one month later, the patient’s lung function improved a lot. Conclusion: In conclusion, endobronchial hamartomas are one of benign neoplasms. It can cause persistent bronchial obstruction and recurrent pneumonias. In this case, invasive endoscopic treatment provides an excellent outcome.

We present a rare case of giant endobronchial hamartoma coexisting with lung atelectasis for more than 3 years. The small specimen initially biopsied via bronchoscope did not reveal tissue features, but some features were suspicious for squamous cell carcinoma. The lesion was removed completely using snare electrocautery combined with argon plasma coagulation via flexible fiberoptic bronchoscopy. The patient made a satisfactory recovery, and a pathological diagnosis was made. This could be a useful option in selected endobronchial tumors.

Pulmonary hamartomas are rare benign tumors consisting of multiple mesenchymal cell lines like cartilage, bone and fat. We discuss an interesting case of a 53-year-old male patient, who was referred to our clinic for persistent cough. Chest X-ray revealed a left suprahilar density associated with plate like atelectasis, which on chest CT was found to be a densely calcified nodule, causing narrowing of the left upper lobe (LUL) bronchus with calcified bilateral hilar lymph nodes. A bronchoscopy revealed a smooth endobronchial mass with calcification, which was removed. Histopathology revealed pulmonary hamartoma.

A best evidence topic was written according to a structured protocol. The question addressed was: in surgically fit patients with biopsy proven symptomatic endobronchial hamartoma (EH), is surgical resection superior to bronchoscopic resection in terms of outcome. A total of 756 articles were identified using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. Three studies included patients who had either bronchoscopic or surgical treatment of EH in the same study. Modalities of surgery included performing a lobectomy, segmentectomy, bronchotomy and a pneumonectomy. Complete resection was 100% in the surgical group and ranged from 8% to 100% in the group treated bronchoscopically. Morbidity was present in 1 patient in a single study (6.6%) in the form of a pneumothorax after a bronchoscopic resection. No mortality was recorded in any study. A follow-up period of 16.2, 26 and up to 60 months showed recurrence of 26.7%, 12% and 0% respectively in the groups treated by bronchoscopy and no recurrence in the surgical group. Four studies looked at bronchoscopic treatment only for EH. Modalities of treatment included mechanical resection, laser, cryotherapy and Argon plasma coagulation. Complete resection ranged from 50-100% with patients achieving only partial resection requiring repeated endoscopic sessions. Morbidity was present in 3 out of the 4 studies; 1 case of pneumothorax in each of 2 studies (4.4% and 2%) and 25% morbidity rate in the third study (pneumothorax/airway stenosis). No mortality was present in any study. One study reported no recurrence after a median follow-up of 12.2 months, while another reported 50% recurrence, although the follow-up period was not stated. The final study included patients with EH treated only by surgical resection due to end stage lung damage caused by prolonged endobronchial obstruction. The majority of resections (71.4%) were in the form of lobectomies. Two major morbidities were recorded (28.5%) with no mortality. After a mean follow-up period of 7 years, no recurrences were recorded. To conclude, in biopsy proven symptomatic EHs, bronchoscopic treatment should be the first choice except in patients with end stage lung damage requiring surgical resection. Morbidity is low with pneumothorax the most common complication. Patients may require multiple sessions for complete removal as a significant recurrence rate is present, but is usually managed effectively by repeated bronchoscopic management.

Hamartoma is a benign lung tumor. Parenchymal hamartomas are usually asymptomatic, but endobronchial hamartoma can present with features of obstruction. Here, we present a case of a young man who presented with nonresolving pneumonia. His bronchoscopy showed an endobronchial hamartoma.

Introduction Most hamartomas are located peripherally in the lung parenchyma and are rarely identified as an endobronchial lesion. Clinically patients with an endobronchial hamartoma are often symptomatic and may present with various symptoms including: fever, wheezing, hemoptysis and obstructive pneumonia. Case presentation A 68-year-old man presented with complaints of fever and cough for 1 month. Chest X-ray revealed a right infrahilar density, which on chest CT was found to be a lesion obstructing the superior segmental bronchus of the right lower lobe and extending outside of the bronchus. A round rubbery mass obstructing the same segmental bronchus was noticed during bronchoscopy and endoscopic biopsy yielded a pathological diagnosis of hamartoma. Discussion Bronchoscopy is most helpful in diagnosis and management of endobronchial hamartomas but if the lung distal to the obstruction is irreversibly damaged or imaging studies suggest that tumor extends outside of the bronchus, pulmonary segmentectomy, lobar resection or even pneumonectomy may be indicated. Conclusion When a benign tumor of the lung, as endobronchial hamartoma, is located in a segmental bronchus and presents extrabronchial spread, we recommend to perform a parenchymal-sparing surgical resection. In this case surgical team, however, should keep in mind, due to difficult individual dissection of the segmental bronchovascular elements, the possibility of conversion from VATS (video-assisted thoracic surgery) to open thoracotomy.

Most of the endobronchial lesions are malignant in origin. In rare instances, benign lesions occupying the endobronchial tree can mimic malignant neoplasms on conventional imaging tests. We present a case of a middle-aged male patient who was admitted to our hospital with recurrent hemoptysis concerning for lung cancer on computed tomography (CT) of the chest. Biopsy of the mass obtained via bronchoscopy revealed a benign lesion most consistent with lipomatous hamartoma, which is known to constitute only 10% of all pulmonary hamartomas. We also present the data of a comprehensive literature review of the epidemiology, clinical symptoms, diagnosis, treatment, and prognosis of patients with endobronchial hamartomas.

Endobronchial lipomatous hamartoma with hilar extension is a very rare benign disease of the airway. A 78-year-old male with coronary artery disease and a coronary stent presented with worsening shortness of breath. The workup included a computed tomography (CT) scan of the chest that showed a nearly obstructive lipomatous endobronchial lesion in the right bronchus intermedius with 2 cm hilar extension of the lipomatous mass. We performed a robot-assisted resection of the lipomatous mass using the “five on a dice” port placement for the Da Vinci Xi robot. In order to fully obtain the exposure necessary to resect the mass and the endobronchial lesion, we performed a right lower lobe superior segmentectomy. The margin of the parenchyma was determined using indocyanine green angiography and divided with the robot blue load stapler. The mass was carefully separated from the pulmonary artery and divided from the endobronchial portion. The frozen section showed that it was a lipomatous mass without any signs of malignancy. We then resected the endobronchial mass with robot scissors and the pathology was consistent with benign lipomatous hamartoma. Two sutures were placed as retraction sutures to pull the airway away from the pulmonary artery. We then closed the opening with absorbable sutures in an interrupted fashion. There was no air leak at the end of the case. The patient went home on postoperative day 3 without any complications and with his shortness of breath resolved. The use of the Da Vinci Xi robot allows for a successful minimally invasive method of resecting a rare endobronchial hamartoma with hilar extension.

Endobronchial hamartoma (EH) is a rare benign tumor of the bronchial tree. This tumor can obstruct the bronchus or cause bleeding. The treatment method is chosen according to location and extent of the tumor. Endobronchial hamartoma can be resected via bronchoscopic approach; surgical therapy, is alternative only for cases where the tumor cannot be resected completely through endoscopy, or if irreversible pulmonary changes secondary to obstruction of the bronchus occurred. We herein describe a 52-year-old female presented with progressive dyspnea and treated with diagnosis of asthma. In this patient, EH which is located in the left main lobe bronchus was found in radiologic assement. Bronchoscopy revealed a broad-based mass obstructing the bronchus. The tumor was resected after coagulation of the tumor with argon plasma coagulation, by the rigid bronchoscope. Pathologic diagnosis was reported as EH. This report highlights the success of rigid bronchoscopic approach in the management of EH.

The coexistence of lung cancer with another endobronchial malignant lesion is well known, although lung cancer with endobronchial hamartoma is infrequent, and requires accurate oncologic evaluation of the endobronchial lesion prior to potential surgical treatment of the lung cancer. These entities can lead to significant diagnostic confusion when encountered together and lead to inappropriate patient staging and treatment. We describe a patient with an undiagnosed endobronchial mass and a biopsy-proven lung cancer. She presented at another institution and was considered unresectable. She was then successfully managed by a staged approach using initial complete bronchoscopic resection of the endobronchial mass, which was found to be benign but completely obstructing the airway, and subsequent right upper lobectomy and mediastinal lymphadenectomy. The right upper lobe mass was squamous carcinoma and was ultimately stage 1A disease.

Endobronchial hamartoma is a rare tumour. We report a 65-year-old woman with a history of recurrent pneumonia. Bronchoscopy revealed a 1 cm endobronchial mass obstructing the left upper lobe bronchus. Histopathological examination was consistent with a pulmonary hamartoma. This lesion was successfully debulked endoscopically with the use of a flexible cryoprobe without any complications. This case highlights both the importance of investigating recurrent pneumonia and the usefulness of endoscopic recanalisation in an obstructed segmental bronchus.

Rationale: Endobronchial hamartoma, the most common benign lung tumor, is located in the bronchus, and it easily mimics lung cancer or bronchial metastasis. Endobronchial hamartoma can cause coughing, hemoptysis, and pulmonary infection; thus, it should be treated right away by surgery or fiberoptic bronchoscopy. Patient concerns: We report a rare case of endobronchial hamartoma in which the clinical symptoms and imaging overlapped strongly with malignant lung tumor contralateral endobronchial metastasis. Diagnoses: Endobronchial hamartoma coexisting with a malignant lung tumor. Interventions: Fiberoptic bronchoscopy was conducted, and the pathologic diagnosis was hamartoma. A second fiberoptic bronchoscopy was conducted, and fine-needle aspiration cytology of the enlarged lymph nodes indicated squamous cell carcinoma. Outcomes: The clinical symptoms were relieved, and the treatment options were docetaxel, cis-dichlorodiamineplatinum, and endostatin. Lessons: Fiberoptic bronchoscopy needs to be guided by imaging and can be considered an effective method for the diagnosis of endobronchial hamartoma.

Background and Aims: Pulmonary hamartomas appear as parenchymal or endobronchial lesions, the latter representing ‘1.4 to 11%’ of the total number of pulmonary hamartomas. Endobronchial hamartomas usually emerge as a single mass. As they are accepted as benign tumors, endobronchial treatments are recommended today. 45 year-old male patient admitted with cough, phlegm and fever. A lesion totally obstructing the right main bronchus was found in CT. Methods: In his brochoscopy, a mobile, smooth-surfaced lesion obstructing right main bronchus was seen. Its histopathology was reported as ‘hamartoma.’ Results: The lesion was removed by using argon plasma coagulation and electrocotery. After the removal of the lesion in right main bronchus, another lesion with similar characteristics was seen in the intermedius bronchus and this lesion which histopathology was reported as ‘hamartoma’ was excised by using electrocauter snare. There was no recurrence in the 24 month follow-up. Conclusion: Reports of multiple endobronchial hamartomas are rare in the literature, and the awareness of this form of benign disease is important in the differential diagnosis of pulmonary diseases.

Patient: Male, 66 Final Diagnosis: Endobronchial hamartoma Symptoms: Fever Medication: — Clinical Procedure: Flexible bronchoscopy • surgical resection Specialty: Pulmonology Objective: Unusual clinical course Background: Post-obstructive pneumonia occurs in the presence of airway obstruction, usually caused by lung cancer. However, there are cases of bronchial obstruction due to benign origin such as foreign bodies and benign endobronchial tumors, which are often misdiagnosed. Case Report: A 66-year-old man was referred to our hospital due to high fever with abnormal shadow in the right lung. Chest computed tomography after a course of antibiotic treatment showed an intra-bronchial tumor obstructing the right upper bronchus. Part of the tumor was removed with flexible bronchoscopy, and histopathological examination revealed cartilage tissue but not fat or other components. Lobectomy of the right upper lobe of the lung was performed to make a definite diagnosis and prevent recurrent obstructive pneumonia. The resected tumor contained mature cartilage and fat tissues, and was diagnosed as endobronchial hamartoma. Conclusions: Benign endobronchial tumors such as hamartomas should be considered in the differential diagnosis of post-obstructive pneumonia.

Hamartomas are the most common type of benign tumours of the lung, constituting a small portion of all lung neoplasms. Hamartomas are rare benign tumours composed of multiple mesenchymal cell lines. Two clinical types have been defined according to the location: intraparenchymal and endobronchial, more frequently the former. We present a case of endobronchial hamartoma causing significant blockage of the right middle lobe. The finding was incidental on a CT scan of the chest done for staging purposes for a large mixed lytic and sclerotic lesion that was found within the proximal-mid portion of the tibial diaphysis. The endobronchial lesion was removed by hot electrocautery snare during bronchoscopy and identified as a hamartoma. Argon plasma coagulation was applied to the lesion’s base afterwards and the patient was to follow-up in 3 months for a repeat CT scan.