CRA42 WHEN BENIGN BECOMES BLOCKED: ENDOBRONCHIAL HAMARTOMA MASQUERADING AS MALIGNANT AIRWAY OBSTRUCTION

Muhammad Fakhrurrazi Muhammad Sabki¹, Arvindran Alaga¹, Haidi Mohamad², Noor Idayu Ibrahim²

¹Respiratory Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah
²Pathology Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah

Introduction
Pulmonary hamartomas are the most common benign lung tumors, composed of disorganized mesenchymal elements. While typically peripheral and asymptomatic, about 10% occur endobronchially, causing airway obstruction and symptoms that mimic malignancy. We present two such rare cases, underscoring their diagnostic and therapeutic challenges.

Case Series
Case 1: A 57-year-old male with recurrent pneumonia underwent bronchoscopy, revealing a mass obstructing the LB8 bronchus. Tumor debulking was performed under conscious sedation. Histopathology showed a hamartoma with hyaline cartilage and smooth muscle. The patient remained asymptomatic on follow-up.

Case 2: A 68-year-old smoker with chronic cough and radiographic right lung collapse had CT findings of an endobronchial mass in the right main bronchus, causing total occlusion of the right middle and lower lobe bronchi. Rigid bronchoscopy with cryoprobe-assisted debulking was done. Histopathology confirmed a hamartoma with ossified cartilage and fat.

Discussion
Though benign, endobronchial hamartomas can mimic malignancy or infection due to airway obstruction. Symptoms include cough, recurrent pneumonia, hemoptysis, and dyspnea. Imaging may show characteristic features like “popcorn calcifications,” but histopathology is essential for diagnosis. Both cases demonstrate the importance of bronchoscopy for diagnosis and management.

Conclusion
Endobronchial hamartomas are rare but important differential diagnoses in patients with persistent respiratory symptoms. Early recognition and bronchoscope management are key to preventing complications. Greater awareness is needed, particularly in Southeast Asia where prevalence data are limited.