What are Hamartomas?
Hamartomas are benign and relatively common tumors, which are made of normal tissue instead of cancerous cells. However, hamartomas can be a cause of serious worry to the patient, as they look a lot like cancer on the imaging studies. A good example of hamartomas is a pulmonary hamartoma where there is development of non-cancerous tissues made of connective tissue, fat and cartilage which is found in the lung region. Hamartomas are seen in men more than women. The exact cause of hamartomas is not clear; however, they can be hereditary.
What is the Difference Between Normal Tissue and Hamartoma?
The primary difference between normal tissue and a hamartoma is that the growth of hamartomas occurs in a disorganized mass. Majority of the hamartomas grow at a slow rate, which is like normal tissues.
What Causes Hamartomas?
The exact cause of hamartomas is not clear. Hamartomas can be hereditary in some patients and found in patients with genetic syndromes like Cowden’s disease.
Hamartomas and Cowden Syndrome
Hamartomas are commonly seen in patients with Cowden’s disease where it develops as a part of this disease. The common cause of Cowden’s disease is an autosomal dominant genetic mutation which means that the patient has about 50% chance of getting this mutation if either one of the parents have it.
What are the Symptoms of Hamartomas?
Hamartomas do not always cause symptoms. Patient may feel discomfort because of the pressure on the adjacent tissues and organs exerted by the hamartoma. These hamartoma symptoms depend on the location of the hamartoma. Fear experienced by the patient is the commonest “symptom” of hamartomas, as these benign tumors are very similar to cancer when seen on the imaging tests.
Types & Location of Hamartomas
Hamartomas can grow anywhere; but there are some more common areas of development of hamartomas such as:
Lungs/Pulmonary Hamartomas: These are the commonest type of benign lung tumors and are often accidentally discovered on a chest x-ray or CT scan of the chest which is done for other reasons. Pulmonary hamartomas developing near the airway can result in obstruction leading to bronchiectasis and pneumonia.
Skin Hamartomas: A Hamartoma can develop anywhere on the skin; however, the more common areas of growth of hamartoma on the skin include lips, face and neck.
Hypothalamus/Hypothalamic Hamartoma: The location of hamartomas is the hypothalamus, which is located within a confined space in the brain. Due to this, the patient has symptoms from the pressure on the adjacent structures exerted by this benign tumor, which include personality changes, seizures and early onset of puberty.
Heart/Cardiac Hamartoma: Hamartoma occurs as a commonest heart tumor in children and produce symptoms of heart failure.
Spleen/Splenic Hamartoma: Hamartomas can form on the spleen and cause abdominal pain in the patient.
Kidneys/Renal Hamartomas: Hamartomas can be found on the kidneys on imaging studies done for some other problem. Patient may have symptoms of kidney dysfunction in renal Hamartomas.
Can Hamartoma Cause Cancer?
People suffering from Cowden’s disease are at increased risk for developing cancers, especially of thyroid and breast. In such cases, thorough examination of the patient is done to exclude cancer.
How Can Hamartoma be Differentiated from Cancer?
It can be difficult to differentiate Hamartomas from cancer. However hamartomas do have some distinguishing characteristics which set them apart from cancerous tumors and these are:
- Hamartomas have the look of popcorn calcification on the images which helps in diagnosing them.
- What hamartomas do not have is cavitation, where there is breakdown in the centre of the tissue.
- The size of the hamartomas is commonly less than 2 inches in diameter.
Can Hamartomas Metastasize or Spread?
No, hamartomas do not usually spread to other parts of the body. However, patient can experience symptoms from hamartomas due to the pressure caused by them on the adjacent structures.
How are Hamartomas Diagnosed?
Diagnosis of Hamartoma can be made with a fine needle biopsy. Other than this, diagnostic features of Hamartoma include:
- Popcorn calcification in Hamartoma.
- Hamartomas rarely have cavitation in them.
- The size of the Hamartomas is lesser than 2 inches across the middle.
How are Hamartomas Treated?
Treatment for a hamartoma depends on the location of the tumor and whether the patient is experiencing any symptoms from it. If the patient does not have any symptoms from hamartomas, then it is likely that no treatment is done and the tumor is observed over time.
Surgery to remove a Hamartoma is done only if the patient is having any symptoms or if the diagnosis is not clear regarding the tumor being cancerous or benign. Surgeries done for pulmonary hamartomas include wedge resection, lobectomy and pneumonectomy.