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Maki Y, Okada K, Nakamura R, Hirano Y, Fujiwara T, Yamasaki R, Ichimura K, Matsuura M. A case of multiple lung carcinoid tumors localized in the right lower lobe. Respir Med Case Rep 2022; 38:101679. [PMID: 35656094 PMCID: PMC9151731 DOI: 10.1016/j.rmcr.2022.101679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 12/05/2022] Open
Abstract
Typical pulmonary carcinoid (TC) tumors are low-grade neuroendocrine tumors and usually detected as indolent solitary tumors. We herein report a case of multiple pulmonary carcinoid tumors and tumorlets localized in the right lower lobe with no underlying lung disorders suggesting diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). A 28-year-old man with multiple 1-to-8-mm pulmonary nodules in the peripheral pulmonary parenchyma of the right lower lobe was referred to our hospital. The patient underwent a surgical biopsy. Pathological examination revealed multiple nodules composed of spindle cells, and immunohistochemistry revealed staining for chromogranin A, synaptophysin, and CD56, suggesting neuroendocrine tumors. He was diagnosed as having multiple TC tumors and tumorlets. Neuroendocrine cell hyperplasia (NECH) was also observed on some bronchioles. A follow-up CT scan after 6 months showed no changes in the sizes of the nodules and no new lesions. The present case was histopathologically compatible with DIPNECH but it occurs mainly in elderly women. The patient might be in an early stage of DIPNECH before progression to symptomatic DIPNECH. In conclusion, clinicians should consider the possibility of carcinoid tumors and tumorlets in cases with multiple pulmonary nodules even if they are localized in one lobe.
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Affiliation(s)
- Yuho Maki
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
- Corresponding author. Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan.
| | - Kazuhiro Okada
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Ryuji Nakamura
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yutaka Hirano
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshiya Fujiwara
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Rie Yamasaki
- Department of Pathology, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kouichi Ichimura
- Department of Pathology, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Motoki Matsuura
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
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Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: DIPNECH. Curr Opin Pulm Med 2021; 27:255-261. [PMID: 33927131 DOI: 10.1097/mcp.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare premalignant condition. Over the past decade, there has been increased recognition and reporting of DIPNECH in the literature. Currently, our understanding is that DIPNECH has a predilection to nonsmoking females around their sixth decade of life. The patients usually present with chronic cough, dyspnea, and computed tomography (CT) showing multifocal pulmonary nodules with associated mosaic attenuation. The clinic history is largely driven by constrictive obliterative bronchiolitis, which typically has an indolent course with progressive respiratory decline and difficult to treat symptoms. RECENT FINDINGS DIPNECH has been found to be associated with carcinoid tumors. Recent data has found that symptomatic DIPNECH patients respond to somatostatin analog (SSA). SSAs provide improvement in symptoms and pulmonary function tests. According to small studies and case series SSAs can be used in conjunction with steroids and bronchodilators for the treatment of respiratory symptoms. SUMMARY DINPNECH is a premalignant condition that can transform into carcinoid tumors. Although the recent data suggest the potential efficacy of SSA, further studies are needed to validate such results in prospective fashion in addition to investigating other therapeutic agents.
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Brandolini J, Bertolaccini L, Pardolesi A, Solli P. Surgical treatment of synchronous multiple neuroendocrine lung tumours (case series): is more always better? ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:423. [PMID: 29201875 DOI: 10.21037/atm.2017.08.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary neuroendocrine lung tumours are uncommon neoplasm; the presence of multiple and synchronous lesions is rare, and few case report are described in the literature. We present a case series of three patients without particular symptom and radiologic finding of multiple synchronous pulmonary nodules. All the patients underwent surgical treatment; histopathologic examination revealed typical carcinoid tumours in all three cases (one patient has a synchronous atypical carcinoid). No oncological progressions were observed at follow-up. A review of current literature is also presented with a suggested strategy management.
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Affiliation(s)
- Jury Brandolini
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospitals, Forlì, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospitals, Forlì, Italy
| | | | - Piergiorgio Solli
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospitals, Forlì, Italy
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Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia and Neuroendocrine Hyperplasia of Infancy. Clin Chest Med 2016; 37:579-87. [DOI: 10.1016/j.ccm.2016.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rossi G, Cavazza A, Spagnolo P, Sverzellati N, Longo L, Jukna A, Montanari G, Carbonelli C, Vincenzi G, Bogina G, Franco R, Tiseo M, Cottin V, Colby TV. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia syndrome. Eur Respir J 2016; 47:1829-41. [DOI: 10.1183/13993003.01954-2015] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/15/2016] [Indexed: 11/05/2022]
Abstract
The term diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) may be used to describe a clinico-pathological syndrome, as well as an incidental finding on histological examination, although there are obvious differences between these two scenarios. According to the World Health Organization, the definition of DIPNECH is purely histological. However, DIPNECH encompasses symptomatic patients with airway disease, as well as asymptomatic patients with neuroendocrine cell hyperplasia associated with multiple tumourlets/carcinoid tumours. DIPNECH is also considered a pre-neoplastic lesion in the spectrum of pulmonary neuroendocrine tumours, because it is commonly found in patients with peripheral carcinoid tumours.In this review, we summarise clinical, physiological, radiological and histological features of DIPNECH and critically discuss recently proposed diagnostic criteria. In addition, we propose that the term “DIPNECH syndrome” be used to indicate a sufficiently distinct patient subgroup characterised by respiratory symptoms, airflow obstruction, mosaic attenuation with air trapping on chest imaging and constrictive obliterative bronchiolitis, often with nodular proliferation of neuroendocrine cells with/without tumourlets/carcinoid tumours on histology. Surgical lung biopsy is the diagnostic gold standard. However, in the appropriate clinical and radiological setting, transbronchial lung biopsy may also allow a confident diagnosis of DIPNECH syndrome.
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Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia of the Lung (DIPNECH): Current Best Evidence. Lung 2015; 193:659-67. [DOI: 10.1007/s00408-015-9755-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/17/2015] [Indexed: 12/11/2022]
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Carr LL, Chung JH, Duarte Achcar R, Lesic Z, Rho JY, Yagihashi K, Tate RM, Swigris JJ, Kern JA. The clinical course of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Chest 2015; 147:415-422. [PMID: 25275948 DOI: 10.1378/chest.14-0711] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Current understanding of the clinical course of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is poor and based predominantly on small case series. In our clinical experience, we have found that the diagnosis of DIPNECH is frequently delayed because respiratory symptoms are ascribed to other lung conditions. The objectives of this study were to collect and analyze longitudinal clinical data on pulmonary physiology, chest high-resolution CT (HRCT) imaging, and therapies to better delineate the course of disease. METHODS We established a cohort of patients (N = 30) with DIPNECH seen at our institution. We used descriptive statistics to summarize cohort characteristics and longitudinal analytic techniques to model FEV1 % predicted (FEV1%) over time. RESULTS All subjects were women who presented with long-standing cough and dyspnea. The majority had an FEV1% < 50% at the time of diagnosis. Forty percent were given a diagnosis of asthma as the cause for physiologic obstruction. The mean FEV1% for the entire cohort showed no statistically significant decline over time, but 26% of the subjects experienced a 10% decline in FEV1 within 2 years. Among the pathology samples available for review, 28% (five of 18) had typical carcinoids and 44% had associated constrictive bronchiolitis. We propose clinical diagnostic criteria for DIPNECH that incorporate demographic, pulmonary physiology, HRCT imaging, and transbronchial and surgical lung biopsy data. CONCLUSIONS DIPNECH is a female-predominant lung disease manifested by dyspnea and cough, physiologic obstruction, and nodules on HRCT imaging. Additional research is needed to understand the natural history of this disease and validate the proposed diagnostic criteria.
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Affiliation(s)
| | | | | | - Zoran Lesic
- Department of Medicine, National Jewish Health, Denver, CO
| | - Ji Y Rho
- Department of Medicine, St. Anthony Hospital, Lakewood, CO
| | - Kunihiro Yagihashi
- Division of Radiology, Denver, CO; Division of Radiology, CHA Bundang Medical Center, CHA University, Seoul, Korea
| | - Robert M Tate
- Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO
| | - Jeffrey J Swigris
- Department of Radiology, St Marianna University School of Medicine, Kanagawa, Japan
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Chassagnon G, Favelle O, Marchand-Adam S, De Muret A, Revel MP. DIPNECH: when to suggest this diagnosis on CT. Clin Radiol 2014; 70:317-25. [PMID: 25465294 DOI: 10.1016/j.crad.2014.10.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/02/2014] [Accepted: 10/22/2014] [Indexed: 11/17/2022]
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is an under-recognized disease characterized by proliferation of neuroendocrine cells in the bronchial wall. It is considered a pre-invasive lesion for lung carcinoid tumours and is found in 5.4% of patients undergoing surgical resection for lung carcinoid tumours. Other manifestations of DIPNECH include bronchial obstruction and formation of tumorlets. DIPNECH preferentially affects middle-aged women. Patients are either asymptomatic or present with long-standing dyspnoea due to obstructive syndrome that can be mistaken for asthma. At CT, mosaic attenuation with multiple small nodules is very suggestive of DIPNECH. The aim of this review is to describe DIPNECH-related CT features and correlate them with histology, in order to help radiologists suggest this diagnosis and distinguish DIPNECH from other causes of mosaic perfusion.
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Affiliation(s)
- G Chassagnon
- Radiology Department, Hopital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37000 Tours, France
| | - O Favelle
- Radiology Department, Hopital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37000 Tours, France
| | - S Marchand-Adam
- Department of Pulmonary Medicine, Hopital Bretonneau, 2 Boulevard Tonnellé, 37000 Tours, France
| | - A De Muret
- Pathology Department, Hopital Trousseau, CHU de Tours, Avenue de la République, 37170 Chambray-lès-Tours, France
| | - M P Revel
- Radiology Department, Groupe Hospitalier Cochin-Hotel Dieu, Paris Descartes University, Sorbonne Paris Cité, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France.
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Filosso PL, Steering Committee, Asamura H, Brunelli A, Filosso PL, Garcia-Yuste M, Lim E, Papagiannopoulos K, Sarkaria I, Thomas P. Knowledge of Pulmonary Neuroendocrine Tumors: Where Are We Now? Thorac Surg Clin 2014; 24:ix-xii. [DOI: 10.1016/j.thorsurg.2014.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oba H, Nishida K, Takeuchi S, Akiyama H, Muramatsu K, Kurosumi M, Kameya T. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia with a central and peripheral carcinoid and multiple tumorlets: a case report emphasizing the role of neuropeptide hormones and human gonadotropin-alpha. Endocr Pathol 2013; 24:220-8. [PMID: 24006219 DOI: 10.1007/s12022-013-9265-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We report a case of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). We performed immunohistochemical analysis of 17 neuropeptides and human gonadotropin-alpha (hCGα), a trophoblastic peptide that promotes the proliferation of neuroendocrine cells. A 51-year-old woman with no history of smoking was found to have a nodule in the right middle lobe. Upon examination, the nodule was found to comprise diffuse linear and nodular neuroendocrine cell hyperplasia (NECH), numerous pulmonary tumorlets merging with one peripheral carcinoid, and an additional central carcinoid. Immunohistochemical analysis revealed diffuse but intense expression of the general neuroendocrine markers CD56, synaptophysin, and chromogranin A, together with gastrin-releasing peptide (GRP), calcitonin, and hCGα throughout the carcinoids, tumorlets, and NECH. Positive staining was also noted for adrenocorticotropic hormone, corticotropin-releasing hormone, met-enkephalin, vasoactive intestinal polypeptide, neurotensin, and growth hormone-releasing hormone in a few isolated cells of the carcinoids and the tumorlets, but staining for these proteins was entirely negative in the NECH lesions. The presence of these neuropeptides in neuroendocrine tumors might explain the presence of neuropeptide-producing tumors of the lungs, cases of which have been reported over the last 30 years. The preoperative serum proGRP level was high but returned to normal after surgical intervention, indicating that GRP was produced and secreted by carcinoids, tumorlets, and/or NECH lesions. It is also probable that neuroendocrine cells secreted GRP into the interstitium in a paracrine manner, leading to the development of dense fibrosis around the tumorlets. During the preoperative and postoperative periods, no evidence of bronchiolitis obliterans was noted, in contrast to some previously reported cases of DIPNECH.
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Affiliation(s)
- Hanako Oba
- Department of Pathology, Saitama Cancer Center, 818, Komuro, Ina, Kita-adachi, Saitama, 362-0806, Japan,
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Association of small foci of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) with adenocarcinoma of the lung. Pathol Res Pract 2013; 209:578-84. [DOI: 10.1016/j.prp.2013.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/27/2013] [Accepted: 06/25/2013] [Indexed: 11/20/2022]
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Nassar AA, Jaroszewski DE, Helmers RA, Colby TV, Patel BM, Mookadam F. Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia. Am J Respir Crit Care Med 2011; 184:8-16. [DOI: 10.1164/rccm.201010-1685pp] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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