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.