Hamartoma: lung, hypothalamic — treatment, symptoms
Hamartomas called a benign tumor that appears as abnormality in a particular organ. It is believed that the reason hamartoma is a violation of the bookmark and tissue differentiation in the embryonic period. Hamartoma most commonly found in lung and hypothalamus, at least in the liver, mammary gland. Among patients with this diagnosis is dominated by people 30-40 years old, men are several times more than women.
Disputes about the origin hamartoma continues to this day. Some scientists think it is a tumor, other – disease development. This is not surprising because the tumor appears in the fetus as a result of violations of embryogenesis like other vices, however, a hamartoma may increase in size, like any other tumor.
Hamartoma is often asymptomatic for many years does not bother the patient and may be detected accidentally. The increase in size of the tumor, compression of its vessels and the surrounding tissue can lead to a variety of disorders, which the patient to see a specialist. Hamartoma is not prone to malignancy, known in the world not more than 20 cases, when the tumor became malignant hamartoblastoma.
Hamartoma built of those fabrics, which are normally present in the affected organ, which distinguishes it from other disembriogenetic disease – teratoma. As to distinguish these entities from each other or from a malignant tumor of the corresponding localization is sometimes impossible even with the assistance of modern diagnostic procedures, the primary method and to clarify the structure of the tumor, and its treatment is surgery.
The causes and varieties of gamerdom
Today, most researchers recognized that a hamartoma is still a tumor, because it carries the required characteristics of malignancy, such as impaired differentiation of cells, their atypia, excessive uncontrolled reproduction. Being a process that occurred in the embryonic period, it is characterized by a rather motley cellular composition, but the elements of the tumor always coincide with the tissues of the body in which it is located.
In hamartoma can be detected areas of muscle, fat, cartilage, connective tissue, bone islets, and vascular elements. Depending on the predominance of a particular tissue, secrete chondromatous hamartoma, lipomatous, leiomyomatous varieties and other more rare variants.
- Chondromalacia hamartoma is a distinct cartilaginous component, dominant among the other structures of the tumor
- Lipomatosis contains a significant amount of adipose tissue
- Leiomyomata – smooth muscle tissue.
Externally hamartoma represents a node with clear boundaries, dense or densely-elastic consistency, grey, white, pink color on the cut. Hamartoma is usually painless and has a size of about 2 cm, and in larger size the tumor is able to compress blood vessels and surrounding tissue, the ducts of the organ, bronchi, etc. usually show a single education, although it is possible that multiple growth.
Reasons hamartoma are considered violations of the bet bodies in the early stages of fetal development. Probably these anomalies are related to hereditary factors, spontaneous mutations in the genes, the influence of adverse external factors (carcinogens) to the future parents.
Hamartoma of the lung
Hamartoma of the lung – the most frequent localization of this type of tumor, and therefore the term «hamartoma» generally refers to intra-lungs the localization process. It is believed that among all benign tumors and tumor-like processes in the lung tissue to share hamartoma accounts for up to 70% of cases. Education more commonly found in individuals between the ages of 30-50 years old, mostly men.
Due to the large amount of cartilage in hamartoma easy, it used to be called cartilage by the tumor. The tumor is usually located in the peripheral parts of the lungs, often on the right lower lobe. Tumor for a long time does not manifest itself, and grows very slowly, but it intrabronchial location, or near large blood vessels can lead to serious consequences, which do not allow you to ignore the disease or take a wait-and-see tactics.
In the lung are usually detected by a single chondromalacia hamartoma, not exceeding 2-3 cm, although the growth of tumors up to 10-12 cm Among other types of diagnosed leiomyomata, fibrous hamartoma.
Hamartoma of the lung decades asymptomatic, but when localizing in the bronchi region or the root of the lung the signs of a tumour appear earlier than in the case of peripheral tumors.
Symptoms hamartoma easy
With the growth of the tumor in the wall of the bronchus sooner or later there is a violation of its permeability, resulting in lung tissue collapses, the segment or lobe is no longer ventilated, inflammation develops on the type of obstructive pneumonia. Symptoms resembles relapsing broncho-pulmonary inflammation, and when examined, are able to detect the formation that caused such violations. In some cases hamartoma growing in the lumen of large bronchus, it is impossible to distinguish from Central lung cancer when conducting x-ray examination.
For the diagnosis of lung hamartoma usually spend roentgenography of chest organs, computed tomography, MRI, bronchoscopy, and sometimes thoracoscopy with biopsy of the tumor.
Hamartoma of the hypothalamus (brain)
Another important localization of the tumor is considered to be a hamartoma of the hypothalamus. The tumor is rare, and the diagnosis and treatment is often complicated. The swelling can cause quite severe symptoms, so always require treatment. The location of the tumor in the brain leads to symptoms, even at small sizes, so this hamartoma is often detected already in childhood.
Hypothalamus a complex structure and is involved in the regulation of the endocrine glands, autonomic nervous system, determines the emotional state that is responsible for sleep and wakefulness, hunger and satiety, etc. Defeat this part of the brain has quite a variety of symptoms but most commonly hypothalamus hamartoma causing precocious puberty, a kind of convulsions and disorders of thinking and intellect.
Among the symptoms hamartoma brain possible:
- Seizures, often resembling laughter or crying («laugh epilepsy»), there may be generalized convulsions;
- Impaired memory, attention, learning abilities, restlessness, conduct disorder (usually more pronounced in children than in adults);
- Emotional disorders – autism, susceptibility to depression, the possibility of aggression;
- Endocrine pathology;
- Premature puberty.
Hamartoma of the hypothalamus requires a thorough neurological examination, determination of hormone levels and consultation of endocrinologist and CT and brain MRI, which allows to establish the localization and size of tumors.
Hamartoma of the liver
In rare cases, it may be detected hamartoma of the liver. This localization of pathology – the lot of childhood: typically, the tumor is diagnosed in the first two years of baby’s life and only rarely in adults. Often affects the right lobe of the body where the hamartoma is located under the capsule. If the tumor is diagnosed in adults, it can have such a significant size that are available to probe even by the patient himself.
Depending on the histological features of hepatocellular secrete a variety of tumor predominate when liver cells (hepatocytes) and bile rich in bile ducts.
Symptoms of liver hamartoma scarce and nonspecific, and small children and did not accurately report their complaints and their flesh. Pathology of the liver in such cases, suspect in chronic diarrhoeal disorders (diarrhea, constipation), loss of body weight or lack of it set in the child. The danger consists of large hamartoma, compressing the liver parenchyma, bile ducts, large vessels.
To diagnose hamartoma liver typically use ultrasound, as the most available and harmless method, the treatment is always surgical, as rapid growth can lead to compression of the surrounding tissues.
Hamartoma of the breast
Hamartoma of the breast is a kind of tumor that consists of fat, connective tissue and glandular component. It is movable, painless, does not cause any disturbances, but may cause a cosmetic defect, which a woman will refer to a specialist.
Hamartoma can be suspected by palpation of the breast or mammography result. Ultrasound in this case is inefficient, and the punctate tumors found normal tissue of the breast that will not help the diagnostic search. Hamartoma breast shown to remove not only to eliminate cosmetic defect, but also to rule out other neoplasms, including cancer.
Treatment hamartoma is determined by its localization, size, characteristics of the symptoms. In some cases, a small asymptomatic tumor of the patient may be offered surveillance, but because accurate diagnosis is possible only after histological examination of tumor tissue, most doctors still resort to it.
Treatment hamartoma easy
Hamartoma of the lung usually requires surgical treatment, indications for which are:
Depending on the location of the tumor and its size, can be carried out:
- husking (enucleation) of the node;
- the resection of the lung with the tumor;
- to delete a segment (segmentectomy) or lobe of the lung (lobectomy);
- the removal of the entire lung (pneumonectomy).
If possible, engineers try to resort to low-impact interventions, and the need for thoracotomy (opening the chest cavity) is often eliminated because of the use of thoracoscopy. Enucleation or resection is carried out at hamartoma located on the periphery of the body.
Indications for removal of the whole lobe or the entire lung are tumors that cannot be removed by enucleation or resection, for example, when they are located in the region of the root of the lung or deep lung parenchyma. At infringement of function of part of the lung distal to hamartoma, and when multiple nature of the growth of tumors also shows the removal of the proportion or the entire body.
If the tumor is in the bronchus, it is possible to resect during bronchoscopy, this used laser, electrocoagulation, cryotherapy. In the case of complicated flow such hamartoma, often recurrent pneumonia, collapsed lung tissue due to violations of bronchial obstruction produce removal hamartoma resection of section of the bronchus, and the defect is sutured or applied to plastic surgery.
Treatment hamartoma of the hypothalamus
Hamartoma of the hypothalamus always be treated, expectant management in such tumors is not justified. Possible surgery, medication and radiation.
Medication hamartoma of the hypothalamus is usually symptomatic and aimed at eliminating seizures, which are appointed by anticonvulsants. In some cases, conservative treatment is to use agonists to the receptors of the luteinizing hormone. Symptomatic treatment aims to improve the patient’s condition before surgery, the tumor does not eliminate it.
Surgical treatment aims at removal of the tumor, but its location deep in the brain that makes access very difficult and traumatic. Surgeons try to choose the endoscopic technique when the tumor is removed through the third cerebral ventricle, or microsurgical operations with access through the ethmoid bone.
In recent years, the traditional surgical intervention gives way to radiosurgery (gamma-knife, cyber-knife), when the tumor is irradiated with a thin beam of radiation under the control of CT or MRI. Methods non-invasive, do not require long-term rehabilitation and finding inpatient. Radiosurgery has been used successfully in many types of brain tumors, including, if hamartoma of the hypothalamus. The main advantage of the method is no need of craniotomy and manipulation of the nervous tissue of the brain, and since the hypothalamus is inaccessible to the surgeon’s scalpel, radiosurgery is often the treatment of choice. In severe condition of the patient and high risk of surgical complications priority is also given to irradiation.
Treatment other hamartoma
When hamartoma other sites showing their removal. So, similar tumors in the liver are excised along with the affected segment or lobe of the organ. When hamartoma breast surgery is needed to eliminate cosmetic defect or when the patient wishes to remove a small tumor. Since confirm hamartoma histology is not always possible when carrying out the puncture, the operation necessary for the differential diagnosis with other tumors of the breast.
The prognosis is usually good hamartoma. The disease does not recur, and symptoms caused by a tumor, over time, eliminated medication. Ways to prevent the tumor from each of us not there she laid still in the embryonic period, but preventive measures still relate to the parents, the duty of which is to lead a healthy lifestyle and in every way to protect their future offspring from adverse external conditions.