An unusual case report of multiple pulmonary leiomyomatous hamartoma

Abstract

Rationale: Multiple pulmonary leiomyomatous hamartoma (MPLH) is an extremely rare benign disease that mostly occurs in women of reproductive age. Patient concerns: A 32-year-old female patient recently diagnosed with multiple bilateral pulmonary nodules. She has the symptoms of dry cough, chest tightness, dyspnea on exertion. Chest X-ray identified multiple bilateral pulmonary nodules in the lung, and the diameter of the largest nodule was about 3.1 cm. Diagnoses: Pathology confirmed the diagnosis of MPLH based on morphology and immunohistochemical staining. Interventions: The patient presented with multiple well-defined nodular shadows in chest computed tomography (CT), atypical image and symptoms were detected. Positron emission tomography/CT scan showed mild fluorine-18 fluorodeoxyglucose uptake in the lesions and no abnormal foci in any other parts of her body. She subsequently underwent a video-assisted thoracoscopic surgery with wedge resection of the biggest one of the nodules. Then the patient given symptomatic treatment, without hormone, no further treatment was prescribed. Outcomes: The patient is in the good general condition and without obvious pulmonary symptoms after the follow-up of 1 year, chest CT scan showed no significant changes in the sizes and locations of her bilateral pulmonary nodules. Lessons: Due to its rare presentation, the primary MPLH may be undiagnosed. Awareness of main morphologic and immunohistochemical features of MPLH is critical for the recognition of this uncommon disease.

The clinicopathological challenges of symptomatic and incidental pulmonary hamartomas diagnosis

“…The differential diagnosis of PHs also includes myxoid peripheral nerve sheath tumor and primary pulmonary myxoid sarcoma, in lung biopsy samples that include only the fibromyxoid component. In these cases, the lack of atypical feature and the low proliferative index certified by Ki-67 support the PH diagnosis [ 25 , 28 , 29 ]. The conventional PHs treatment is usually the surgical resection [ 15 ].…”