Giant pulmonary hamartoma

Pulmonary hamartomas are usually an incidental finding and range in size from 1 cm to 8 cm in diameter in various series. We report a case of a massive pulmonary hamartoma (size 25.5 × 17.5 × 6.5 cm and weighing 1134 g) in a 61 year old male who presented with a short history of breathlessness. The tumour was arising from the medial border of the right lung and occupying most of the right chest extending in to the anterior mediastinum. The tumour was compressing the right lung and there was no evidence of infiltration into the surrounding structures. It was successfully treated by surgical resection and final histology was pulmonary hamartoma with predominantly adipose and leiomyomatous differentiation.     

Giant cystic chondroid hamartoma of the lung

Pulmonary hamartoma composed of an abnormal mixture of mesenchymal elements is the most common benign neoplasm in the lung. Pulmonary hamartoma larger than 10 cm and the cystic variant are also very rare.We describe an asymptomatic 11-year-old boy with a huge mass in the right hemithorax. Chest computed tomography revealed a heterogeneous mass filling the middle and the lower lobes of the right lung. The patient underwent thoracotomy and resection of the lesion. Gross examination of the surgical specimen showed a well-circumscribed, encapsulated, lobulated, and bluish-white mass, measuring 18 × 16 × 8 cm. Multilocular cystic spaces with intervening lobulated fragments of cartilaginous tissue and adipose tissue were seen. Microscopically, the solid component was composed of cartilage and adipose tissue. Cystic areas and cleft-like spaces were lined by ciliated columnar epithelium.We believe this is the first case of ‘giant cystic chondroid hamartoma of the lung’ described in childhood. We suggest that giant cystic pulmonary hamartoma should be included in the differential diagnosis of large intrathoracic masses in children.     

巨大十二指肠错构瘤致慢性贫血1例报告并文献复习

背景与目的 十二指肠错构瘤（BGH）是十二指肠良性肿瘤中比较少见的类型,因其临床表现不典型、缺乏特异性,导致术前诊断困难,往往易被漏诊或误诊,主要依靠术后病理确诊。巨大BGH的病例临床更是罕见。本文报告1例巨大BGH致慢性贫血的诊治过程,并结合既往文献对本病特点进行复习,以期为临床工作提供经验借鉴。方法 回顾性分析西安交通大学附属咸阳市中心医院肝胆外科收治的1例BGH患者的临床资料,结合前期文献资料进行复习总结。结果 患者,女性,49岁;因腹痛伴恶心、呕吐就诊西安交通大学附属咸阳市中心医院肝胆外科。患者既往有慢性贫血病史,月经规律,偶有柏油样便。入院上腹部B超检查见胰头内侧十二指肠部包块;上腹部CT检查见十二指肠降部及水平部肠壁弥漫性增厚,结构不清;上腹部MRI+MRCP检查见十二指肠降部及水平部与邻近空肠分界不清,肠管明显扩张扭曲,肠壁分界不清,肠壁水肿明显,可见同心圆样改变。胃镜检查考虑十二指肠占位,并镜下活检提示符合胃黏膜异位。上消化道造影提示十二指肠降段与水平段移行区近圆形充盈缺损,考虑良性占位可能性大。最终考虑十二指肠占位性病变并引起梗阻,剖腹探查术后行胰十二指肠切除术,切除标本送病理学检查,最终诊断为BGH,免疫组化MUC5AC（+）,术后恢复顺利出院。术后监测血常规,红细胞及血红蛋白逐渐恢复正常,随访12个月,患者一般状况良好,未诉不适,复查各项指标正常,继续随访。结论 巨大BGH致慢性贫血临床罕见,术前影像学检查往往很难提供有价值的信息,胃镜下活检有助于诊断,但阳性率低,最后确诊需依靠手术切除标本的组织病理学检查,病变较大时外科手术切除是治疗该病的有效手段。     

Radical sublobar resection for lung cancer

Sublobar resection (segmentectomy or wedge resection) has not historically been the strategy of choice for treating lung cancer and is performed only as a compromise for patients with early-stage lung cancer accompanied by poor lung function. Although some studies have advocated higher rates of local recurrence and a poorer prognosis after sublobar resection than after lobectomy, most others have found promising outcomes after sublobar resection in selected patients. Yet even now, when early-stage small lung cancers are being detected with increasing frequency, sublobar resection has yet to become the treatment of choice. This review summarizes surgical outcomes of sublobar resection compared with lobectomy in the literature. Current evidence indicates that radical sublobar resection should be considered as an alternative for cT1N0 lung cancer of ≤2 cm, even in low-risk patients. A foundation is thus established for starting a new series of randomized controlled trials, which could bring about revolutionary changes to surgery for lung cancer in the era of early detection. This review was submitted at the invitation of the editorial committee.     

胸腔镜辅助小切口手术诊治肺周围型结节

目的探讨胸腔镜辅助小切口手术在诊断和治疗肺周围型结节病变中的临床应用价值。方法胸腔镜辅助小切口手术诊治肺周围型结节55例，其中单发结节54例，多发结节1例。肺楔形切除术23例；肺叶切除联合淋巴结清扫治疗原发性肺癌32例，采用常规开胸手术器械及胸腔镜用器械切除肺叶，自制淋巴结摘除钳完成淋巴结清扫。结果55例均在胸腔镜下完成手术。手术时间35～180min，平均109min，术中出血量50～400ml，平均122min。均未输血，1例术后漏气术后32d出院，1例切口延迟愈合，术后19d出院，余53例术后住院4～11d，平均8．3d。无严重并发症。术后病理：良性病变15例，原发性肺癌38例，非典型性腺瘤样增生1例，转移性肺癌1例。良性病变行肺楔形切除术，32例原发性肺癌行解剖学肺叶切除联合淋巴结清扫，4例肺癌胸膜广泛播散未手术处理，2例肺癌因肺功能差行姑息性肺楔形切除。结论胸腔镜辅助小切口手术有助于明确诊断肺周围型结节病变，治疗临床早期原发性肺癌的长期疗效有待随访观察。     

Mammary hamartoma

For many years, mammary hamartoma was considered to be an under-diagnosed disease. However, with the increasing use of diagnostic procedures in breast tumors (mammography, ultrasound, fine needle aspiration cytology and core needle biopsy), diagnosis of this entity has increased. Mammary hamartomas normally manifest as painless, mobile, palpable lumps without adherence to skin or muscle. Mammography shows well-circumscribed tumors, separated from adjacent normal breast tissue. Macroscopically they are well-defined tumors, consisting of benign mammary glandular tissue, fibrous stroma and fat in variable proportions, sometimes with a pseudoencapulation. Because of the lack of cytological and architectural specificity of hamartomas, correlation between clinical manifestations, imaging techniques and histology is essential. This report describes a case of an 11-cm mammary hamartoma in a 46-year-old woman.     

Isolated alar cleft associated with hamartoma

Isolated alar cleft associated with hamartoma is a very rare congenital anomaly. In this paper, this rare anomaly is presented with its clinical findings and the treatment.     

Giant mammary hamartoma in a middle aged female. Case report and review of literature of the last 15 years

BackgroundMammary hamartoma is a benign rare tumour occurring in both sexes, with size range mostly between 2–4 cm. Giant breast hamartoma (GMH) is very rare and can reach unexpected sizes in women.Presentation of the caseA 26 year old Egyptian female presented with left breast lump since 3 years, gradually increasing in size, with no other associated complaints. No family history of breast cancer, she did not smoke or consume alcohol, and had no past medical history. Examination revealed a large soft freely mobile mass (12 × 9 cm) in the lower outer quadrant of the left breast at the 3–6 o’clock position. There were no palpable axillary lymph nodes in both sides. Nipples and right breast were normal.DiscussionThe diagnosis of GMH can be made by examination and imaging only. The specific features that appear in mammogram and ultrasound can be used to reduce the need for core biopsy in hamartoma. Wide local excision is curative. We include a review of the literature of cases of GMH > 10 cm published during the last 15 years.ConclusionA non-invasive mammogram and ultrasound provide sufficient evidence of the tumour, hence core biopsy might not be critically required. However, if a breast hamartoma is still clinically suspected but with inconclusive or unequivocal mammographic and ultrasonographic features or if there is suspicion of dysplasia, then invasive core biopsy is justified. Recurrence is low and prognosis is good.     

胸腔镜肿瘤切除术治疗肺错构瘤5例报告

目的：探讨胸腔镜肿瘤切除术治疗肺错构瘤的临床效果。方法双腔气管插管单肺通气,根据肿瘤部位常规做3个胸腔镜切口：腋中线第7或8肋间作为观察口,置入胸腔镜;腋前线第5肋间和腋后线第6肋间作为操作口。胸腔镜下切开结节表面脏层胸膜,沿肿瘤包膜钝性剥离出肿瘤。结果5例手术顺利,无中转开胸,无手术并发症和围术期死亡发生。手术时间平均54 min（30～90 min）,术中出血平均10 ml,引流量平均288 ml（220～350 ml）,术后拔管时间平均2．6 d （2～3 d）、术后住院时间平均3．8 d（3～5 d）,总费用平均23940．51元（15885．95～26670．23元）。5例术后随访1～30个月,平均9．2月,未见肿瘤复发。结论胸腔镜肿瘤切除术是周围型肺错构瘤的首选术式。     

脾脏错构瘤的诊治体会(附六例报告)

目的探讨脾脏错构瘤的诊断和治疗方法。方法回顾性分析我院1994年~2004年收治的6例脾脏错构瘤的临床资料。结果本组6例均行脾切除术,均痊愈出院,随访至今仍健在。结论影像学检查对脾脏错构瘤有一定的诊断价值。外科医生在脾脏占位鉴别诊断时应考虑到本病的可能性。     

Neuro-glial hamartoma of the suprasellar cistern

A unique case of a suprasellar hamartoma in a 29-year-old woman is presented. The lesion was discovered in the context of a work-up for amenorrhea that had lasted 1 year and was resistant to clomiphene and medroxyprogesterone acetate treatment. Magnetic resonance imaging (MRI) revealed a 1.2-cm anterior suprasellar lesion with no appearent connection to the hypothalamus or hypophysis. She underwent surgical resection of the mass. Pathologic examination revealed randomly arranged mature neurons, glial tissue, and myelinated fibers. There was no evidence of gonadotropin-releasing hormone producing neurons on immunohistochemical studies. Postoperative MRI showed complete resection of the lesion, and 1 year later mensus resumed off medication.     

食管错构瘤的影像学特征

目的 总结食管错构瘤的影像学特征.方法 回顾性分析2010年10月吉林大学第一医院收治的1例食管错构瘤患者的临床资料,给予X线钡剂造影、多排螺旋CT平扫及二期增强扫描、食管镜、EUS检查,完善检查后行内镜下肿瘤切除术.术后复查X线钡剂造影.结果 X线钡剂造影检查示食管上段分叶状充盈缺损,表面光滑,食管黏膜连续,局部食管蠕动正常.食管CT检查示食管腔内见分叶状软组织密度影,大小约4.2cm×1.6 cm×1.5 cm,其内密度不均,中间密度近似脂肪样密度;二期增强扫描未见明确强化.食管镜检查示距门齿16 ～ 23 cm处见纵行隆起型粉白色肿瘤,近侧有蒂起源于食管后壁,远端呈结节样隆起,表面颗粒样粗糙,触之柔软,无出血,病变局部管腔狭窄.EUS检查示病灶呈不均质低回声,固有基层增厚明显,外膜边缘粗糙.患者行内镜下肿瘤切除术,术后病理学诊断为错构瘤.术后随访12个月,患者状况良好,复查X线钡剂造影,未见肿瘤复发.结论 食管错构瘤是一种极罕见的良性肿瘤,以进食固体食物出现哽咽感为主要临床表现.CT增强扫描及EUS检查对诊断、鉴别该病变具有重要的意义.     

Hypothalamic hamartoma: the role of surgery

A hypothalamic hamartoma associated with true precocious puberty in a 7-month-old girl is hereby reported. Hormonal studies disclosed elevated serum levels of luteinizing hormone (LH) and follicle stimulating hormone, both of which responded well to LH-releasing hormone stimulation. Following a subtotal removal of the tumor, the clinical manifestations of precocious puberty as well as associated endocrinological abnormalities returned to normal. The role of surgery for this lesion, which appears to be safe when a planned microsurgical course is employed, is discussed.     

隆凸部位原发性肺癌的手术治疗

作者对１３例涉及隆凸部位的中心型肺癌行切除治疗。鳞癌１１例,腺癌２例Ｔ３Ｎ２Ｍ０３例,Ｔ４Ｎ２Ｍ０１０例。根治手术１０例,姑息手术３例。右全肺切除隆凸全切除３例。右全肺切除隆凸部分切除６例,左全肺切除隆凸部分切除１例,右上中叶切除隆凸部分切除下叶隆凸部位吻合３例。无手术并发症及手术死亡。３年治愈率５４％,５年治愈率３０％,１例已存活８年。该类患者如纵隔淋巴结无广泛转移,局部病灶允许切除,手术效果仍较满意。作者对术中血管、支气管隆凸部的处理提出了自己的经验。     

Lipofibromatous hamartoma of the median nerve with macrodactyly of middle finger

Lipofibromatous Hamartoma (LFH) is a rare tumour affecting the peripheral nerves, mostly the median nerve. It is benign and slowly growing. Less than 100 cases have been reported in the literature, about one quarter of them are associated with macrodactyly in the field of the affected nerve.We reported a case of a 13 years old female with LFH of the median nerve at the level of the wrist associated Macrodactyly of the ipsilateral middle finger treated surgically by decompression only.