CYSTIC PULMONARY HAMARTOMA MANIFESTING AS SPONTANEOUS PNEUMOTHORAX

Cystic hamartoma refers to rare benign lung tumors. The literature describes 17 cases of this disease. The tumor may look like multiple bilateral cysts or a solitary single-chamber or multi-chamber cyst of a large size, which makes it difficult to diagnose. The disease can be complicated by spontaneous pneumothorax. The cyst itself often looks like a pneumothorax. An observation of a 52-year-old man complaining of chest pain and shortness of breath is presents. On the x-ray, the left lung is compressed with air, which is regarded as a spontaneous pneumothorax. Two-day drainage did not give any results. The video-assisted thoracoscopic surgery technique was performed and a large air cyst was detected. A conversion to a thoracotomy was made. A cyst of 20×15 cm size originated from the lower lobe, the lung was in atelectasis. Cyst resection and lung decortication were performed. Histological examination of the cyst wall revealed a hamartoma of the lung. The postoperative period was uneventful. Differential diagnosis of cystic hamartoma is conducting with lymphangioleiomyomatosis, air cysts, extrapulmonary sequestration, echinococcal cysts, and lung cancer. Indications for surgery are the following: chest pain, shortness of breath, pneumothorax, and hemoptysis. In a unilateral process, a cyst resection or lobectomy have to be performed. Cystic pulmonary hamartoma should be included in the differential diagnostic range in patients with recurrent spontaneous pneumothorax, hemoptysis, single and multiple lung cysts. It is impossible to determine the diagnosis without a biopsy and histological examination.

Folliculosebaceous Cystic Hamartoma: A Rare Entity

Folliculosebaceous Cystic Hamartoma (FSCH) is an uncommon cutaneous hamartomatous lesion. It is basically a tumour like malformations exhibiting abnormal overgrowth of biphasic elements i.e., epithelial and mesenchymal components that are normally found in the skin. Few other hamartomas of pilosebaceous origin are trichofolliculoma, trichodiscoma, fibrofolliculoma and pilar sheath acanthoma. Though distinct, this entity shares similar histological features to Sebaceous Trichofolliculoma (STF). Hence, a proper histological examination is must in differentiating it from STF and other clinical and histological entities. Authors hereby, describes a case of FSCH in a 37-year-old male who presented with a slow growing cystic mass on his left earlobe, an uncommon location for such lesion. The mass was excised, and a detailed histological evaluation showed a characteristic multinodular growth pattern with lobules of pilosebaceous glands forming nodules around cystically dilated follicular infundibular structures. No hair shafts were seen in the cystic cavity ruling out differential diagnosis of sebaceous hyperplasia which could have been a close mimic. The intervening stroma revealed dense collagen, sheets and lobules of adipocytes, many vascular channels filled with fibrinous deposits. Perivascular adipocytes were also noted along with few nerve tissues (perineurium). A detailed clinicopathological work-up helped in arriving at a final diagnosis of FSCH with neural component. The patient was doing well till last six months of follow-up. No recurrence of similar lesion was noted in the patient.