Causes of hypothalamic hamartoma and methods for diagnosing the disease

A single lesion in the lungs (SLP) is defined as a local area of ​​compaction of lung tissue of a round or similar shape with a diameter of up to 3 cm [15]. This international definition differs from the traditional domestic concept of pulmonary lesions, the source of which is phthisiatric practice (in the classification of pulmonary tuberculosis, the size of lesions does not exceed 1 cm, and larger lesions are defined as infiltrates, tuberculomas and other types of changes) [14, 15].

Pathological formations of the lungs of small size (up to 2 cm) in most cases are detected during computed tomography of the chest, performed for various reasons [10, 11, 14, 16-18].

Some characteristics of space-occupying lesions on CT allow us to judge their nature - benign or malignant, but they are not decisive when making a diagnosis [19]. The nature of the formation can also be judged by the rate of its growth [20].

Meanwhile, based on the results of one CT study, it is often difficult to make a differential diagnosis; repeated studies over time are required. During the inflammatory process, the lesions disappear after 1-2 months. In the case of atypical glandular hyperplasia, the lesions do not change for several years. In adenocarcinoma, increased size and/or increased density as well as vascular convergence may be seen [11, 12].

Focal formations in the lung tissue discovered during such an examination often remain unattended by specialists, which sometimes leads to disappointing results of treatment for this category of patients.

The difficulties of accurately diagnosing focal lung formations are well known - differential diagnosis most often has to be made between peripheral cancer, benign tumor (hamartochondroma, etc.), tuberculoma, sarcoidosis, and metastatic lesions of the lung [1-4, 6, 7, 10, 12].

According to S.V. Miller et al. [8], diagnostic thoracotomy is the final method of comprehensive examination of patients with small round lung formations and provides truly early diagnosis and timely surgical treatment. Consequently, radical surgical intervention undertaken for a round formation in the lung, the genesis of which is unclear, is a method that allows for morphological verification of the early stage of a malignant tumor and performing organ-preserving surgery.

Other authors believe that currently there is no unified approach to determining the nature of focal lung formations. Obviously, with a high risk of a malignant tumor, the optimal approach is the earliest possible morphological verification of the diagnosis. In case of low risk of malignant process, it is more rational to carry out dynamic observation [11].

The result of these actions may be the identification of a group of patients with an obviously benign process, as evidenced by the absence of growth dynamics of the lesion for 2 or more years, the presence of “benign” calcifications, inclusions of fat (hamartoma) or fluid (cyst) in the lesion according to CT data. In such a situation, only observation is necessary. This also includes cases of arteriovenous malformations and other vascular changes, as well as inflammatory processes in the lungs (round tuberculous infiltrate, tuberculoma, mycetoma, etc.), requiring specific treatment [5, 9, 13].

The second possible result is the detection of signs of a malignant process (a lesion with a diameter of more than 1 cm with radiant uneven contours, lesions of the ground glass type and mixed solid type, which should be regarded as potentially malignant), for which morphological verification is necessary in a specialized medical institution [12] .

Every year in Russia over 63 thousand people, including over 53 thousand men, become ill with lung cancer. In more than 20 thousand patients (34.2%), lung cancer is detected at stage IV, so the task of detecting malignant lung tumors in the early stages of their development is extremely relevant [2, 7, 8].

A threatening factor when diagnosing small-diameter lung tumors is their asymptomatic nature. The absence of complaints, the meager clinical picture of the disease, difficulties with prevention and primary detection of lesions make the problem of lung formations up to 2 cm in diameter relevant for scientific research and practically significant for preserving the health and often the lives of patients.

General information

Hamartoma is a benign neoplasm that can affect any organ.
The disease is extremely rare in females; hamartoma is most often diagnosed in men aged 20-40 years and in children. Structurally, the neoplasm consists of organ tissue and may contain blood vessels, fibrous formations, cartilage or adipose tissue. The hamartoma has a round shape, the surface can be smooth or bumpy.

A lumpy benign neoplasm is formed in the organ during embryogenesis. Most often, the pathological process is detected in the pulmonary system, hypothalamus, and mammary gland. It is extremely rare that hamartoma is diagnosed in the liver and spleen.

Pathogenesis

A hamartoma is formed as a result of a violation of cell development in the embryonic period and consists of various elements of embryonic tissues. The development of a tumor is associated with a violation of organ formation and tumor-like growth of tissue components around the future organ.

Despite the early formation of tumor sprouts in the embryonic period, hamartoma may not manifest itself until the patients reach adulthood. The neoplasm consists of the same elements as the organ itself, but is characterized by an incorrect arrangement of components and an unhealthy degree of differentiation. This is what distinguishes a hamartoma from a teratoma , which contains tissue buds that are foreign to a given organ.

Clinical picture

Hamartomas with an intrapulmonary location, as a rule, form and develop asymptomatically. With the progressive growth of a subpleural hamartoma, patients may notice unusual or painful sensations in the corresponding half of the chest. In cases where the hamartoma comes from the wall of the bronchus, its growth may be accompanied by a violation of bronchial obstruction, complaints of cough with the release of a small amount of mucous or mucopurulent sputum appear, hemoptysis is very rarely observed, as well as wheezing in the lungs and shortness of breath, which may be abnormal. interpreted as bronchial asthma.

Classification

The generally accepted classification is based on the predominance of certain tissues in the neoplasm.

Types of hamartomas indicating the predominant tissue:

• lipomatous (fatty);
• chondromatous (cartilaginous);
• fibromatous (connective);
• leulomyomatous (smooth muscle);
• organoid (several types);
• angiomatous (vessels).

Depending on the number of pathological formations, single and multiple foci are distinguished.

Lung hamartoma

Congenital, benign neoplasm. The tumor can contain both lung tissue and adipose, cartilage tissue, as well as blood vessels and fibrous formations. It is considered the most common species among hamartomas.

The pathological process is formed against the background of mutation at the level of growth and differentiation of tissues during gestation in the fetus. After birth, the pathological node continues to grow and develop. The first symptoms may only appear decades later. It is easiest to diagnose a node that contains cartilage tissue. The neoplasm can also include alveolar, epithelial, connective and other types of tissue. The parenchyma is affected subpleurally (on the surface) or intrapulmonary (in the deep layers). Most often, the node is located in the lower lobe of the right lung.

The formation is considered absolutely benign; metastases are not diagnosed. Lung tissue can be damaged only when the tumor a large size. Typically, nodes do not exceed 40 mm in diameter, but in medical practice large neoplasms up to 100 mm are also encountered.

Hypothalamic hamartoma

The hypothalamus is located between the floor of the third ventricle and the diencephalon. This area of ​​the brain is responsible for the functioning of the internal glands and other vital systems. Any structural changes in the hypothalamus lead to serious disruptions in the functioning of the entire organism.

A hypothalamic hamartoma is a benign compaction that consists entirely of organ pathogens and does not contain foreign inclusions. As the hamartoma increases in size, adjacent tissues are compressed, which can negatively affect the patient’s health.

A neoplasm in the hypothalamus also originates at the embryonic stage. The first signs of pathology may appear already in the first year of a child’s life. The cause of the development of hypothalamic hamartoma is considered to be the negative impact of external factors on the body of a pregnant woman, which leads to cell mutation in the fetus.

Hamartoma of the breast

The formation of the neoplasm also begins during the development of the embryo. Breast hamartoma is considered a benign tumor, but it can bring some discomfort to a woman’s life. A cystic neoplasm consists entirely of tissue from the own mammary gland. The first symptoms appear after 30 years. The pathological node is easily palpable, has clear boundaries and moves freely (if its size is more than 30 mm). May cause pain when palpated. Ultrasound examination reveals it as a dense, lumpy formation.

Liver hamartoma

The formation of a benign tumor occurs during the formation of the embryo. At the initial stage, the disease is completely asymptomatic. In 7% of patients, malignancy occurs and the tumor turns cancerous. The disease is detected in childhood. The tumor looks like a dense, lumpy formation. Depending on the structural composition, two varieties are distinguished:

• mesenchymal;
• hepatocellular.

Classification of liver hamartoma by location in the organ:

• near-surface;
• deep;
• subcapsular.

It is also customary to distinguish cystic and fibrous hamartomas, true and biliary tumors.

The danger of the disease lies in the risk of rupture of the neoplasm and the very rapid proliferation of pathological cells. Compression of neighboring organs and tissues is possible. It is important to pay attention to signs such as:

• attacks of nausea;
• excessive thinness;
• fast fatiguability;
• stool instability (alternation of constipation , diarrhea and vice versa);
• muscle weakness.

Hamartoma of other organs

The neoplasm can be located in other human organs and tissues:

• spleen;
• retina and iris (astrocytic form);
• nose (nasal form);
• esophagus, stomach, large intestine (presacral form);
• sebaceous glands;
• The lymph nodes;
• skin of the thighs, buttocks, arms, legs, face (cutaneous hamartoma);
• renal system ( angiomyolipoma ).

Characteristics of the disease

Pulmonary hamartoma (synonyms: lipochondroadenoma, hamartochondroma) is a congenital neoplasm that is not malignant, located in the respiratory organs, and consists of both normal lung tissue and various abnormal inclusions.

There are vessels inside the tumor, that is, it is supplied with blood and fed by substances dissolved in the blood.

ICD 10 pulmonary hamartoma code: Q85.9.

Photo of lung hamartoma

The formation of the lungs is located in the parenchyma of the organ. As a rule, its dimensions are small - about 2-6 cm, and since it does not tend to quickly increase in size or grow into neighboring areas (metastasis), a person can live his whole life without knowing about his illness.

The disease also does not affect neighboring systems and organs; it rarely appears in the form of multiple formations.

Despite this, a certain number of clinical cases have been registered in oncology in which the tumor slowly but surely grew, leading to the appearance of a giant tumor that did not allow the lungs to function normally.

Another danger of pathology is the risk of its degeneration into cancer, which happens in approximately 5-7% of situations.

As for medical statistics, the overwhelming majority of non-cancerous tumors of the respiratory system are hamartomas (more than 65%). They appear more often in boys and men. The prevalence in the general population is not higher than 0.3%. The average age for diagnosing this neoplasm is 50 years; it is most often detected at 40-70 years of age.

In terms of localization, the predominant tumor remains located in the periphery in the anterior parts of the lungs, mainly in the right lung. Very rarely, 2-3 tumors are recorded in two respiratory organs.

In the latter case, a thorough examination should be carried out for the presence of congenital pathologies with the formation of benign neoplasms in all organs and tissues.

The following are the main pathophysiological characteristics of the tumor:

• Appearance – a node in a capsule, or without one, but clearly limited from healthy tissue
• Sectional color – gray, yellowish
• Consistency – densely elastic
• Structure – lobules with fibrous layers
• Surface – smooth or with small bumps
• Size – 1-12 cm, average diameter 5 cm.
• Composition – cartilage, fat, connective, smooth muscle, glandular tissue, blood vessels, lymph cells
• Inclusions – bone, calcareous, cystic

Causes of hamartoma

The mechanism of development of the neoplasm is associated with a violation of the formation of organs during intrauterine development. Pathology can develop under the influence of unfavorable life factors, due to mutations , or against the background of a hereditary predisposition.

During embryonic development, the process of growth and division of cells in the organ is disrupted, which leads to their spontaneous proliferation and improper differentiation. The growth of the neoplasm begins from the moment the child is born and may not manifest itself in any way for several decades.

Causes of pulmonary hamartoma

Pulmonary hamartoma develops against the background of a malformation of the pulmonary system associated with a violation of the formation and formation of bronchopulmonary structures during embryogenesis. The cartilaginous, connective tissue and smooth muscle components of the lung hamartoma take their development from the mesenchyme - the embryonic tissue. Secondarily, epithelial structures are involved in the pathological process during the growth of the tumor.

Predisposing factors are also considered to be gene mutations, genetic predisposition, prolonged exposure to negative factors (ionizing radiation, hazardous chemicals, etc.).

Symptoms of hamartoma

The peculiarity of hamartoma is that the pathological process does not manifest itself in any way for a very long time. The patient seeks medical help only when unpleasant symptoms significantly impair the quality of life. For example, when a tumor reaches a gigantic size and compresses the affected organ or adjacent tissues, which leads to disruptions in their functioning.

Symptoms of pulmonary hamartoma:

• severe shortness of breath ;
• discomfort and pain behind the sternum;
• cough with purulent or bloody discharge;
• pain during inhalation and exhalation.

Symptoms of hypothalamic hamartoma in childhood:

• poor learning ability, restlessness;
• disturbances of memory, thinking, attention and motor activity;
• epileptic seizures , convulsions ;
• loss of consciousness;
• feeling of anxiety and restlessness;
• emotional instability in the form of outbursts of aggression or depression ;
• early puberty;
• disturbances in the functioning of the endocrine system.

Symptoms of a hypothalamic tumor in women:

• gynecomastia;
• amenorrhea;
• galactorrhea;
• thyrotoxicosis;
• uterine bleeding.

Symptoms of liver hamartoma:

• indigestion;
• weight loss;
• constipation, diarrhea;
• periodic feeling of hunger;
• palpation of the tumor or its protrusion when the hamartoma reaches a large size.

Clinical symptoms are extremely mild.

Symptoms of mammary gland hamartoma:

• protrusion of the tumor from the side of the mammary gland when the tumor reaches a large size (cosmetic defect);
• mobility and painlessness of the tumor when palpated.

Hamartoma can manifest itself in completely different ways depending on the specifics and functionality of the affected organ. Neoplasms in the hypothalamus and pulmonary system accompany patients with specific symptoms for a long time.

Hamartomas of the hypothalamus and hepatic system manifest themselves already in childhood. Tumors in the mammary glands and liver manifest themselves very weakly clinically, and the patient is in the dark for a long time about the true cause of the unpleasant symptoms.

Story

A cartilaginous tumor of the lung was first described in medical literature in 1845 by the German physician Hermann Lebert (English) Russian. (Hermann Lebert, 1813-1878). The histological structure and macroscopic picture were later studied by Rudolf Ludwig Karl Virchow, 1863, Hans Chiari (English) Russian. (Hans Chiari, 1883), Felix Victor Birch-Hirschfeld (Felix Victor Birch-Hirschfeld, 1887), Maurice Letulle (French) Russian. (Maurice Letulle, 1897), A.I. Abrikosov (1903), Hart (1906), however, reports of intravital detection of cartilaginous lung tumors appeared only in the 20th century, which is associated with the advent and development of radiology. Already by 1926, according to Hickey and Simpson, there were 40 cases of detection of cartilaginous lung tumors in the world literature. Subsequently, due to the successful development of thoracic surgery, reports of the detection of pulmonary hamartomas increased significantly.

For a long time, there was no consensus in scientific medical circles about the causes of cartilaginous lung tumors. Hans Chiari, who discovered this formation against the background of bronchiectasis, believed that cartilaginous tumors arise against the background of chronic inflammation. Similar views were held by Rudolf Virchow and Johann Orth (German) Russian. (Johannes Orth) and some other pathologists. Will suggested that pulmonary chondromas arise from the so-called “bronchiogenic tissue” - embryonic gill arches. All of the above scientists agreed that hamartomas are true tumors. However, back in the late 19th and early 20th centuries, Felix Victor Birch-Hirschfeld, Maurice Letul and A.I. Abrikosov believed that cartilaginous tumors arise in the embryonic period from elements of the bronchial tree (according to A.I. Abrikosov, this point of view was confirmed presence of adenomatous structures in these formations).

The term “hamartoma” was first proposed by the German pathologist Eugen Albrecht (1872-1908) in 1904 when describing liver dysembryoplasia. In 1922, Feller first used this term to refer to lung tumors, since he believed that all benign lung tumors described by that time could be classified as hamartomas. In 1930, Bayer used this term to refer to cartilaginous lung tumors containing other tissue elements. Goldsworthy in 1934 used the term "hamartoma" to refer to benign lung tumors consisting primarily of a combination of fat and cartilage tissue.

Important: Sore throat and runny nose, cough, but no fever, what to treat?

Despite the fact that hamartoma is not an organ-specific pathological condition, currently in the world medical literature the term “hamartoma” is usually used in relation to lung formations.

Tests and diagnostics

Any neoplasm causes some concern, especially if its true nature is unknown. Certain diagnostic research methods make it possible to determine the exact location and nature of the tumor.

When examining a patient, the doctor pays attention to factors such as:

• severity of reflexes;
• skin sensitivity;
• full functioning of the vestibular apparatus;
• muscle tone, balance, proper coordination of movements.

The patient must undergo tests to determine the level of sex hormones.

Instrumental methods for diagnosing hamartoma:

• radiography (for pathology of the pulmonary system);
• ultrasound examination (if tumors are suspected in the mammary glands, abdominal organs);
• fibrobronchoscopy (if pathology in the lungs is suspected);
• MRI or CT (diagnostic search in the hypothalamus).

Various research methods make it possible to determine the exact location of the tumor. Quite often, a diagnostic search is difficult due to the small size of the pathological focus, as well as the location of the abnormal node inside the organ (hypothalamus, lungs) and the similarity of the cellular composition of the tumor with healthy tissues of the organ.

Content

• 1. History
• 2 Epidemiology
• 3 Etiology and pathogenesis
• 4 Pathological anatomy
• 5 Classification 5.1 Based on tissue predominance
• 5.2 By number of tumors
• 5.3 By localization

Treatment of hamartoma

Treatment tactics largely depend on the location of the tumor, its size and volume, as well as clinical symptoms.

If the tumor is small and the clinical picture is mild, regular medical observation is sufficient. However, most often treatment for hamartoma is aimed at removing the tumor.

Treatment of pulmonary hamartoma

• in case of peripheral localization of the tumor, curettage or partial resection of the affected organ is performed;
• when a pathological node is located near the root of the lung or in its depth, as well as when several nodes are identified at once, they resort to removing a lobe of the lung. In some cases, complete removal of the organ is necessary;
• in case of damage to the bronchi, surgical treatment is carried out using cryodestruction, electrocoagulation, and laser. The goal is to remove the pathological area while preserving as much of your own healthy tissue as possible.

Treatment of hypothalamic hamartoma

A neoplasm in the brain poses a particular danger, which requires timely and competent treatment. Therapy can be carried out medically or surgically depending on the diameter of the tumor.

Drug therapy can reduce the severity of negative symptoms and eliminate convulsive syndrome. Drug therapy is also used before surgery.

Modern medicine allows, through radiosurgical treatment, to avoid excessive brain trauma during tumor removal. Using a tomograph, the operating doctor monitors the direction of the radiation beam. This technique is very popular because... avoids craniotomy and preserves brain tissue as much as possible. Radiosurgical treatment is especially important in patients with a high risk of complications and those in difficult situations.

Treatment of hamartoma of other localization

When hamartoma affects other organs and tissues, surgical treatment is most often used. Surgical intervention is necessary primarily for differential diagnosis of the identified neoplasm (for example, with damage to the mammary glands).

Pathology prognosis

The tumor rarely recurs; only 7% of cases of recurrent development of compaction after surgery have been recorded. Immediately after removal of the seal, regular examination by a pulmonologist is recommended for 2-5 years. Hamartoma is sometimes hidden, when even after diagnostic studies it is not immediately visible.

Painful symptoms disappear immediately after recovery in the postoperative period. The role played by doctors preserving most of the respiratory organs. When only the tumor is removed from the lung tissue, the patient recovers quickly. But if a lobe resection was performed, the standard of living deteriorates.

It is important to find out in time what pulmonary hamartoma is and undergo examinations and listen to the body. This way you can avoid complications.

Author: Evgeniya Leshenkova Therapist, pulmonologist

Prevention

Due to the fact that the tumor-like node begins to form during embryonic development and is partly due to genetic factors, there is no specific prevention.

It is almost impossible to predict in advance at what stage of development a failure will occur. However, parents can make their contribution to the birth of a healthy baby. To do this, it is necessary to minimize all risks associated with the negative impact of the environment on the health of the expectant mother.

Parents are advised to adhere to a healthy lifestyle, give up bad habits, and unquestioningly follow the instructions of the attending physician. Particular care should be taken when taking medications, especially during pregnancy.

Only with the right organizational approach to bearing and giving birth to a baby can the risk of developing pathology be significantly reduced, even with a genetic predisposition to neoplasms.

Consequences and complications

Hamartoma is characterized by gradual growth. The tumor is characterized by extremely slow growth, so patients do not show any complaints for a long time. Complications can occur if the tumor grows excessively. Increasing in size, the hamartoma disrupts the functioning of not only the organ in which it is located, but also in nearby organs and tissues due to compression.

When a hamartoma is located in the lungs, damage can be caused to the bronchial tree, the lumen of which is compressed under the influence of growing tumor tissue. When identifying multiple nodes, the doctor faces a very important task - to exclude a rare genetic pathology - Cowden's disease , which is characterized by the formation of tumors in other internal organs and tissues.

The danger lies in the risk of malignancy, which is accompanied by the appearance of papillomas and warts on the mucous membranes and skin.

If a hypothalamic hamartoma is located in the diencephalon, then the patient may experience mental disorders, loss of consciousness, inappropriate behavior, and convulsive activity.

If the hamartoma is located in the liver, then internal bleeding may occur when the tumor grows and ruptures. With the accelerated growth of a liver hamartoma and the filling of its contents with cystic components, there is a high risk of developing cancer.

In case of breast hamartoma, it is also extremely important to carry out timely differential diagnosis to exclude breast cancer .

Instrumental research

X-ray picture of a large hamartoma of the upper lobe (second segment) of the right lung

X-ray of the lungs

On radiographs, hamartomas with intrapulmonary localization have the appearance of single (much less often - multiple) spherical shadows (solitary pulmonary nodes) with clear, slightly wavy contours; with a lobular structure, the outlines of the tumor may be lumpy. Characteristic are calcareous inclusions located in the form of individual grains or in the form of a central conglomerate. Often the intensity of the shadow of the central part of the tumor is much higher than that of the marginal parts (a distinctive feature of hamartoma from other tumors). The pulmonary pattern around the hamartoma is usually unchanged. Sometimes there is a rim along the periphery (tumor bed). Characterized by the absence of changes in the root of the lung and pleural reactions. With long-term dynamic observation, the size of the hamartoma changes extremely slowly, but the intensity of calcareous deposits often progresses.

Due to the characteristics of radiological manifestations, 4 types of hamartomas are distinguished:

1. Hamartomas with an irregular, spherical or oval shape, clear smooth or lumpy contours, having a very high shadow intensity, which decreases towards the periphery of the hamartoma. Characteristic are point, spotty and linear calcifications, clearly visible on direct and lateral radiographs, which merge into a single conglomerate.
2. Hamartomas of medium intensity, having sharply defined smooth or lumpy contours and chaotic deposition of lumps of lime in the thickness of the tumor.
3. Hamartomas with single or multiple foci of calcification located both in the thickness of the hamartoma and along its periphery.
4. Hamartomas without calcification.

Endobronchial hamartomas are manifested by direct (spherical tumor-like formation in the lumen of the bronchus with smooth and clear contours on X-ray tomography) and indirect signs (various radiological manifestations of bronchial obstruction: hypoventilation, atelectasis or bloating, pendular displacement of the mediastinum, secondary bronchiectasis).

Computed tomography of the chest

CT image of a large hamartoma of the upper lobe (second segment) of the right lung.
The main advantage of computed tomography over plain chest radiography in examining patients with pulmonary hamartoma is the possibility of a more detailed assessment of the internal architecture of the tumor due to obtaining thin sections. In this regard, calcium and fat inclusions are better visualized with computed tomography than with radiography.

When computed tomography of the chest organs, hamartomas of all histological varieties are differentiated in the form of an oval-shaped volumetric formation with clear contours of various diameters, located against the background of unchanged lung tissue without reaction of the nearby interlobar or costal pleura. In approximately half of the cases, the structure of the hamartoma is heterogeneous: either due to centrally located areas of calcification (in 15-30%), or due to areas of density reduced to −130 (adipose tissue, in 34-50%). The combination of fat and calcium inclusions in one tumor is a characteristic sign of hamartoma. The frequency of calcification increases with the size of the hamartoma: from 10% for tumors less than 2 cm to 75% for hamartomas larger than 5 cm. When the tumor is located in the mantle part of the lung, it has emphasized contours and a smooth surface, and when the hamartoma is localized in the thickness of the lung tissue, it is removed from the root, the pole has emphasized contours and a smooth surface, while the pole facing the root of the lung remains clear, but acquires a wavy character due to many short fibrous strands extending into the lung tissue. The characteristic orientation of the long axis of a hamartoma is also noted: when this tumor is located in any part of the lung tissue, its long axis is always directed towards the root of the lung.

When computed tomography with bolus contrast enhancement of the image, a gradual increase in the density of the hamartoma is noted throughout all contrast phases. It is characteristic that in the arterial phase the increase in tissue density of the formation occurs by 57.2%, in the venous phase - by 26.4%.

Fiberoptic bronchoscopy

Fiberoptic bronchoscopy makes it possible to diagnose hamartoma in cases where it comes from the bronchial wall. Endobronchial hamartoma can be located on the walls of the bronchi or in the area of ​​the bronchial “spur”, has a spherical or cone-shaped shape, whitish color and a wide base. The mucous membrane covering the hamartoma is not changed. On instrumental palpation, it has a stony density, which causes significant difficulties when taking a biopsy from the tumor.

Transbronchial ultrasound examination performed during fibrobronchoscopy allows for targeted transbronchial puncture biopsy of a hamartoma located near the bronchus. Cytological examination of the material obtained in this way makes it possible to clarify the diagnosis and determine further treatment tactics.

Ultrasound-guided transthoracic puncture

As a rule, ultrasound examination (ultrasound) is not used to detect pulmonary hamartomas. However, in the presence of a subpleural hamartoma adjacent to the chest wall, it is possible to visualize it during ultrasound examination with targeted puncture biopsy of the tumor through the chest wall under ultrasound guidance. Performing transthoracic puncture biopsy is also possible under the control of computed tomography.

Forecast

The prognosis is considered favorable if the tumor is detected early and adequate therapy is received. In this case, the tumor does not increase in size, and the unpleasant symptoms are controlled with medication.

Hamartoma is a benign tumor that rarely undergoes changes at the cellular level and forms metastases. In world practice, there are about 20 cases of degeneration of a hamartoma into a malignant tumor - hamartoblastoma .