Small Pulmonary Lesions - a challenge for thoracic surgery ?

Article type: Research Article

Authors: Kayser, Klaus | Dünnwald, Delia | Zink, Stefan | Kayser, Gian

Affiliations: Department of Pathology, Thoraxklinik, Heidelberg | Department of Cardiovascular Surgery, Freiburg, Germany

Note: [] Address for correspondence: Prof. Dr. Dr. K. Kayser Department of Pathology Thoraxklinik Amalienstr. 5 D-69126 Heidelberg, Germany Tel.: +49-6221-396496 FAX: +49-6221-396238 e-mail: klkayser@lung.de

Abstract: Purpose and subject of the study: To analyze the diagnosis, potentially associated external and clinical features, and surgical procedures of small pulmonary lesions, especially hamartomas in relation to peripheral T1 lung carcinomas and lymphoid hyperplasia. Material and methods used: This prospective study comprises 103 patients undergoing enucleation or resection of pulmonary hamartomas during the years March 1, 1995 December 31, 2000. The causes of surgical intervention, pre-surgical diagnoses, surgical procedures, location, size and histological compartments were analyzed as well as clinical features potentially associated with the tumors (alcohol, smoking, chronic lung diseases). Follow up of patients lasted for 5.5 years at maximum. For comparison, 36 patients with peripherally T1 lung carcinomas are included as well as 50 cases with lymphoid hyperplasia. Results obtained: The sex and age distribution of the patients with hamartomas was comparable to that of patients with lymphoid hyperplasia. About 75% of men and 55% of women were heavy smokers having a history of 30 (27) pack years at average. In 84% of patients the lesions were incidentally detected in chest radiographs whereas 12 % of patients underwent thoracic surgery suspicious for intrapulmonary metastases of known extrapulmonary malignancies. Enucleation was performed in 21%, and wedge resection in 77% of cases. At average, hamartomas were smaller than T1 lung carcinomas and quite larger in comparison to lymphoid hyperplasia. No recurrent tumors or additionally detected hamartomas were noted during the follow up, and both surgical procedures (enucleation or wedge resection) were identical in curative treatment. All patients with peripherally localized T1 tumors underwent lobectomy. The3/5 year survival rate was calculated to 69/52%. Lymphoid hyperplasia is of clinical importance for the estimation of prognosis in patients with metastatic disease as the number of radiologically suggestive metastatic nodules can often be significantly changed due to this entity. Conclusion: Pulmonary hamartomas are benign lesions, which display certain clinical associations with malignant lung carcinomas in respect to external risk factors, and to lymphoid hyperplasia. Both surgical procedures (enucleation or wedge resection) can be performed giving identical results in respect to treatment.

Keywords: Pulmonary hamartoma, T1 carcinoma, lymphoid hyperplasia, diagnosis, surgical treatment, prognosis

Journal: Electronic Journal of Pathology and Histology, vol. 7, no. 3, pp. 04-04, 2001