CASE REPORT
A 61-year-old man was evaluated in the pulmonary clinic because of a
right hilar mass on a simple chest X-ray detected by a national health
screening program in South Korea. He was a 30 pack-years current smoker.
He had a mild dry cough with scanty sputum persisting for more than six
months at his visit, but there was no history of fever, hemoptysis,
dyspnea, chest pain, weight loss, night sweats, and other systemic
symptoms. He was an office worker, and his past and family histories
were unremarkable.
Initial vital signs were stable: Blood pressure, 138/86 mmHg, heart
rate, 72/min, respiration rate, 16/min, and temperature, 36.5℃. There
was a slightly reduced breath sound intensity on the right upper
posterior chest on chest auscultation, and other systemic physical
examinations were normal. A simple chest X-ray showed a well-marginated
round mass in the right hilum, which was increased in size compared with
the previous chest X-ray taken two years before. (Figure 1) The
contrast-enhanced chest computed tomography (CT) was additionally
performed, and it revealed about 3.5 cm sized high-density mass
obstructing the right upper posterior segmental bronchus. (Figure 2) The
bronchoscopic examination showed a pedunculated, red mass completely
obstructing the right upper posterior segmental bronchus. A pinkish,
hyaline-like core material with a rigid surface was observed after
peeling off the surface mucosa by biopsy procedure. (Figure 3)
In the suspicion of a tumor with the cartilage component, including
hamartoma and chondroma, video-assisted thoracoscopic surgery (VATS) was
done. The tumor was removed in total and measured 4.0×2.5 cm after
excision (Figure 4). The histopathology of the excised tumor revealed a
bronchial enchondroma composed of lobules of mature hyaline cartilage
separated by normal cancellous bone or marrow without adipose tissue and
smooth muscle component suggesting hamartoma. (Figure 5) In
consideration of the possibility of the Carney triad, no specific
findings were observed during gastroscopy, and there was no symptom and
sign suggesting paraganglioma by repeated examinations. The patient
recovered from surgery, and the dry cough resolved on his visit to the
pulmonary clinic one month after tumor removal.