Pulmonary Chondroid Hamartoma With Nontuberculous Mycobacterial Infection

Solitary pulmonary nodules (SPNs) can be manifested in a variety of disorders including neoplasms, infection, inflammation, and vascular or congenital abnormalities. In addition, they are often accompanied with other pulmonary pathologic lesions such as consolidations and several pulmonary disorders present as similar pulmonary nodular lesions simultaneously. Diagnostic workup is important for these SPNs; however, many physicians often miss the second diagnosis for multiple pulmonary lesions with SPNs due to lack of clinical suspicion that each pulmonary nodule or pathologic lesion can have each other’s diagnosis. Herein, we report 2 cases of coexistence of pulmonary chondroid hamartoma with nontuberculous mycobacterial (NTM) infection presenting as pulmonary nodules and multiple consolidative lesions. A 60year-old man was admitted for the evaluation of multifocal pulmonary lesions including SPN with chronic exertional dyspnea. Multiple lung tissues were obtained from each lesion through percutaneous transthoracic needle biopsy (PTNB). At the same time, bacteriologic examination was performed using respiratory samples obtained by bronchoscopy. Based on pathologic and microbiologic results, the patient diagnosed as pulmonary chondroid hamartoma with pulmonary NTM infectious disease. In addition, a 56-year-old woman visited for the evaluation of a small SPN. The SPN was resected surgically for the pathologic examination and turned out to be pulmonary chondroid Moon, MD, Su Ji and So Ri Kim, MD, PhD patients were treated with the standard antibiotics against MAC as recommended by the ATS/IDSA guideline. This is the first report of 2 patients, as far as we know, that chondroid hamartoma and NTM disease develop simultaneously in the lung. This report emphasizes that physicians should endeavor to confirm the individual diagnosis for the various pulmonary abnormal lesions detected at the same time, if necessary through multifocal biopsies for each lesion. (Medicine 94(14):e689) Abbreviations: CT = computed tomography, HRCT = highresolution computed tomography, NTM = nontuberculous mycobacterial, PTNB = percutaneous transthoracic needle biopsy, SPNs = solitary pulmonary nodules. INTRODUCTION T he majority of solitary pulmonary nodule (SPN) cases represent either lung cancers or benign granulomas, and these conditions occur with roughly equal frequency. The most common cause of benign granulomas is tuberculoma; this is particularly true in tuberculosis-endemic regions. Hamartoma is defined as an abnormal mixture of tissue elements or an abnormal proportion of a single element, normally present in an organ. Pulmonary chondroid hamartoma is the most common benign neoplasm arising in the bronchial wall and accounts for 7% to 14% of all SPNs. Usually they present as asymptomatic SPNs, with gradually increasing in size. Thus, they need to be differentiated from lung malignancies. The radiographic findings of nontuberculous mycobacterial (NTM) lung disease are variable, depending, in part, on the species. Similar to other granulomatous infections, NTM infection can occasionally result in the formation of an SPN, in which the majority of these lesions were detected incidentally. Although NTM infections can be found as cavitary or bronchiectatic lesions predominantly, they can present as consolidation or infiltration in the lung. Based on this information, we can guess the overlap of radiologic findings among various pulmonary disorders. However, in clinical practice, physicians often miss the coexistence of 2 diseases due to lack of clinical suspicion. In this report, we describe 2 cases of coexisting pulmonary chondroid hamartoma with NTM.