|Year : 2021 | Volume
| Issue : 2 | Page : 128-130
Vascular hamartoma - A rare soft tissue tumor on the back
Shrihari Chandrasekaran1, Nirmal Kumar Palaniyappan1, Jacob Jayakar Raju Mandapati1, Indira Gunasekaran2
1 Department of General Surgery, Pondicherry Institute of Medical Sciences, Puducherry, India
2 Department of Pathology, Pondicherry Institute of Medical Sciences, Puducherry, India
|Date of Submission||09-Sep-2021|
|Date of Acceptance||30-Oct-2021|
|Date of Web Publication||30-Dec-2021|
Department of General Surgery, Pondicherry Institute of Medical Sciences, Puducherry
Source of Support: None, Conflict of Interest: None
Hamartoma is a nonneoplastic proliferation of mature cells and tissues indigenous to the affected part. They are classified as lipomatous, neurogenic, vascular, angiomatous, etc., based on the predominance of tissue in them. This is a case of vascular hamartoma of the infrascapular region in a young male. He was evaluated elsewhere with magnetic resonance imaging and incisional biopsy and referred to our institute for further management. After initial contrast-enhanced computed tomography of the thorax, the mass was excised surgically with adequate margins and the wound was closed primarily. The final biopsy report of the mass showed a vascular hamartomatous lesion. Hence, hamartoma should be considered one of the differentials for a soft-tissue mass found anywhere in the body and proper preoperative imaging and planning of appropriate intervention is necessary.
Keywords: Contrast-enhanced computed tomography thorax, incisional biopsy, magnetic resonance imaging, vascular hamartoma
|How to cite this article:|
Chandrasekaran S, Palaniyappan NK, Raju Mandapati JJ, Gunasekaran I. Vascular hamartoma - A rare soft tissue tumor on the back. J Curr Res Sci Med 2021;7:128-30
|How to cite this URL:|
Chandrasekaran S, Palaniyappan NK, Raju Mandapati JJ, Gunasekaran I. Vascular hamartoma - A rare soft tissue tumor on the back. J Curr Res Sci Med [serial online] 2021 [cited 2022 Jun 28];7:128-30. Available from: https://www.jcrsmed.org/text.asp?2021/7/2/128/334464
| Introduction|| |
Hamartoma is defined as a nonneoplastic proliferation of mature cells and tissues indigenous to the affected part. They have little or no malignant transformation rate. Hamartomas commonly occur in the skin, chest wall, lungs, liver, gastrointestinal tract, and kidneys. According to the predominance of tissue, they can be classified as lipomatous, neurogenic, vascular, angiomatous, osseous, and chondroid. The incidence of most of the hamartomas remains unknown except pulmonary hamartoma, in which the incidence rate is approximately 0.25%. Here, we present a case of hamartoma of the infrascapular region in a young male.
| Case Report|| |
A 27-year-old man came with complaints of swelling in the left upper back of 1-year duration. He was apparently well 1 year ago, following which he developed a swelling in his left upper back which was insidious in onset and gradually progressive in size to reach the current size of approximately 15 cm × 10 cm in size over this time. It was not associated with pain, redness, warmth, no history of trauma before a year, and no other swellings elsewhere in the body. There was no significant family or occupational history. He was evaluated elsewhere with magnetic resonance imaging which showed a solitary fibrous tumor with vascular component in the intermuscular plane and an excision biopsy of the lesion was tried and was reported as hemangiopericytoma. In view of severe bleeding post biopsy, definitive excision was deferred and he was referred to our institute for further management. On examination, the swelling was present in the left infrascapular region, measuring 15 cm × 7 cm in size, placed obliquely over the teres major and part of the latissimus dorsi muscle. There was a small ulcer over the swelling healed by secondary intention, indicating the biopsy site.
He was evaluated and posted for wide local excision of the tumor under general anesthesia. The tumor was excised completely with adequate margins using harmonic scalpel and sent for histopathological examination. The wound was primarily closed with drains placed. The biopsy report revealed a hamartomatous lesion with a prominent vascular component. Postoperatively, he recovered well, developed a surgical site infection on one part of the suture site, and was managed with regular dressings. The wound was allowed to heal by secondary intention. The imaging, intraoperative picture, and histopathological slide are given in [Figure 1] and [Figure 2].
|Figure 1: Computed tomography images cross-section and coronal views, with iv contrast showing a well enhancing vascular lesion in the left upper back in the intermuscular plane (arrows)|
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|Figure 2: Excised specimen variable-sized vascular channels (arrows) with admixed adipose tissue (asterisk) and collagen fibers|
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| Discussion|| |
The term hamartoma was first used by Albrecht in 1904 to refer to a congenital abnormal mixing of the normal components of an organ. Hart (1906) was the first to give this name to the pulmonary tumors which had been described even earlier. Hamartoma is defined as nonneoplastic malformation characterized by proliferation of mature cells and tissues indigenous to the affected part. Excess of one or more tissues in a disorganized manner can occur. Usually, hamartomas are present at birth or in young age but also reported in later ages of life. Hence, diagnosis of hamartomas cannot be made on the age factor. The incidence of pulmonary hamartomas is 0.25%, but for other sites, it is not known.
Hamartomas are usually asymptomatic, even if present at birth, and may not be apparent until adolescence or adulthood. The differential diagnosis for this tumor is a hemangioma. However, it is termed as hamartoma due to the presence of fibro-adipose tissue, collagen fibers, nerve bundles, and peripherally placed skeletal muscle fibers in a predominantly unencapsulated benign lesion composed of variable-sized vascular channels. They show the haphazard or bizarre arrangement of tissue indigenous to the site of the tumor.,
From a clinical standpoint, a vascular hamartoma may grow rapidly, slowly, or not at all. Those that have the tendency to grow rapidly also have the tendency for spontaneous involution. It is of particular interest that the growth of these tumors is dependent upon the anatomical part of the vascular tree involved in the deformity. Such a large vascular hamartoma is very rare. Other soft-tissue tumors that can arise in this region are lipoma, liposarcoma, rhabdomyoma, rhabdomyosarcoma, fibrosarcoma, neuroma, neurofibroma, and schwannoma.
The treatment of hamartoma includes methods such as watchful waiting, sclerosant injection, tattooing, arterial embolization, and surgical excision with reconstruction. Newer methods of treatment include systemic steroid therapy, embolism with thrombin–gelfoam pledgets, laser therapy, and interstitial reconstructive surgery. Vascular hamartoma is a rare case and such a large hamartoma is very rare. Thorough preoperative assessment is required to avoid unnecessary problems during excision.
| Conclusion|| |
Here, we present a rare case of intermuscular vascular hamartoma which has to be considered a cause of swelling along with other soft-tissue tumors. Proper preoperative imaging helps in determining the tissue of origin of the tumor for planning surgery and adequate reconstruction or other interventions such as embolization, cryotherapy, and laser therapy.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]