Pulmonary Hamartoma Associated With Lung Cancer (PHALC Study): Results of a Multicenter Study

Abstract

Purpose Pulmonary hamartoma is the most common benign tumor of the lung. We analyzed a 20-year historical series of patients with pulmonary hamartoma undergoing surgical resection, aiming to evaluate the characteristics, the outcomes, and the association between hamartoma and lung cancer. Methods It was a retrospective multicenter study including the data of all consecutive patients with pulmonary hamartoma undergoing surgical resection. The end-points were to evaluate: (i) the characteristics of hamartoma, (ii) outcomes, and (iii) whether hamartoma was a predictive factor for lung cancer development Results Our study population included 540 patients. Upfront surgical or endoscopic resection was performed in 385 (71%) cases while in the remaining 155 (29%) cases, the lesions were resected 20 ± 3.5 months later due to increase in size. In most cases, lung sparing resection was carried out including enucleation (n = 259; 48%) and wedge resection (n = 230; 43%) while 5 (1%) patients underwent endoscopic resection. Only two patients (0, 2%) had major complications. One patient (0.23%) had recurrence after endoscopic resection, while no cases of malignant degeneration were seen (mean follow-up:103.3 ± 93 months). Seventy-six patients (14%) had associated lung cancer, synchronous in 9 (12%) and metachronous in 67 (88%). Only age > 70-year-old (p = 0.0059) and smokers > 20 cigarettes/day (p < 0.0001) were the significant risk factors for lung cancer. Conclusion PH was a benign tumor, with no evidence of recurrence and/or of malignant degeneration after resection. The association between hamartoma and lung cancer was a spurious phenomenon due to common risk factors.

The clinicopathological challenges of symptomatic and incidental pulmonary hamartomas diagnosis

“…These data are supported by the results of a recent study, which demonstrated PHs and lung cancer association in 10.5% of cases [11]. Similar results were registered by another research team which revealed that 26% of patients had associated cancer, 12% of them being diagnosed with extrapulmonary malignancies (breast, gastric, and colon carcinoma) [10]. In our study group, a history of breast cancer was registered in one case, but the possibility of a secondary cancer was excluded.…”

“…The “hamartoma” term derives from “hamartia”, which means “erroneous” or “faulty”, in Greek [ 8 ]. From a historical perspective, Eugen Albrecht used, for the first time in 1904, the term “hamartoma”, to characterize a local cellular and tissular proliferation, typically found in the organ of origin [ 10 ]. Three decades later, Goldsworthy has defined PH as a local benign proliferation of hyaline cartilage and bone [ 10 ].…”

“…From a historical perspective, Eugen Albrecht used, for the first time in 1904, the term “hamartoma”, to characterize a local cellular and tissular proliferation, typically found in the organ of origin [ 10 ]. Three decades later, Goldsworthy has defined PH as a local benign proliferation of hyaline cartilage and bone [ 10 ]. Usually, PHs are identified in middle and older age groups, with a men predominance [ 5 , 11 ].…”

Relationship Between the Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) and Lung Adenocarcinoma Patterns: New Possible Insights

“…The diffusing capacity of the lung for carbon monoxide(DLCO) is a pulmonary function test that measures the pulmonary performance for gas exchange from inhaled air into the blood stream, thus representing a marker of lung damage and mostly intended for diffuse alterations of alveolo-capillary barrier.Indeed, DLCO is reduced in patients with emphysema, interstitial lung disease and pulmonary brosis as well as in various other lung diseases [1].In addition, DLCO has been related to postoperative morbidity, mortality and overall survival(OS) in patients with non-small-cell lung cancer(NSCLC), with low DLCO values negatively affecting OS probably because of the occurrence of pulmonary complications [2][3][4][5][6][7][8][9][10][11][12].In 2011, the ATS/ERS/IASLC proposed a new classi cation of lung ADC [13], which was issued by the World Organization of Health(WHO) in 2015 [14].There were introduced and reclassi ed several different patterns of ADC with peculiar pathological features and related clinical behaviours, well demonstrated and validated by several authors [15][16][17][18] and consequently holding prognostic relevance [19][20][21][22].Among them, low DLCO values -re ecting a reduced pulmonary function-has been associated to histopathological indexes of tumour aggressiveness [23] and these observations suggested that lung damage may be associated with tumour carcinogenesis.We aimed to investigate the relationship between DLCO and lung ADC histopathological aggressiveness and to evaluate if more aggressive ADC develop in more severely damaged lung.…”

Relationship between the diffusing capacity of the lung for carbon monoxide (DLCO) and lung adenocarcinoma patterns: new possible insights

“…The diffusing capacity of the lung for carbon monoxide(DLCO) is a pulmonary function test that measures the pulmonary performance for gas exchange from inhaled air into the blood stream, thus representing a marker of lung damage and mostly intended for diffuse alterations of alveolo-capillary barrier.Indeed, DLCO is reduced in patients with emphysema, interstitial lung disease and pulmonary brosis as well as in various other lung diseases [1].In addition, DLCO has been related to postoperative morbidity, mortality and overall survival(OS) in patients with non-small-cell lung cancer(NSCLC), with low DLCO values negatively affecting OS probably because of the occurrence of pulmonary complications [2][3][4][5][6][7][8][9][10][11][12].In 2011, the ATS/ERS/IASLC proposed a new classi cation of lung ADC [13], which was issued by the World Organization of Health(WHO) in 2015 [14].There were introduced and reclassi ed several different patterns of ADC with peculiar pathological features and related clinical behaviours, well demonstrated and validated by several authors [15][16][17][18] and consequently holding prognostic relevance [19][20][21][22].Among them, low DLCO values -re ecting a reduced pulmonary function-has been associated to histopathological indexes of tumour aggressiveness [23] and these observations suggested that lung damage may be associated with tumour carcinogenesis.We aimed to investigate the relationship between DLCO and lung ADC histopathological aggressiveness and to evaluate if more aggressive ADC develop in more severely damaged lung.…”