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Asmundo L, Ambrosini V, Anderson MA, Fanti S, Bradley WR, Campana D, Mojtahed A, Chung R, Mcdermott S, Digumarthy S, Ursprung S, Nikolau K, Fintelmann FJ, Blake M, Fernandez-Del Castillo C, Qadan M, Pandey A, Clark JW, Catalano OA. Clinical Intricacies and Advances in Neuroendocrine Tumors: An Organ-Based Multidisciplinary Approach. J Comput Assist Tomogr 2024; 48:614-627. [PMID: 38626756 DOI: 10.1097/rct.0000000000001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
ABSTRACT Neuroendocrine neoplasms (NENs) are rare neoplasms originating from neuroendocrine cells, with increasing incidence due to enhanced detection methods. These tumors display considerable heterogeneity, necessitating diverse management strategies based on factors like organ of origin and tumor size. This article provides a comprehensive overview of therapeutic approaches for NENs, emphasizing the role of imaging in treatment decisions. It categorizes tumors based on their locations: gastric, duodenal, pancreatic, small bowel, colonic, rectal, appendiceal, gallbladder, prostate, lung, gynecological, and others. The piece also elucidates the challenges in managing metastatic disease and controversies surrounding MEN1-neuroendocrine tumor management. The article underscores the significance of individualized treatment plans, underscoring the need for a multidisciplinary approach to ensure optimal patient outcomes.
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Affiliation(s)
| | | | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - William R Bradley
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Davide Campana
- Department of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ryan Chung
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Shaunagh Mcdermott
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Subba Digumarthy
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Stephan Ursprung
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Konstantin Nikolau
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael Blake
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ankur Pandey
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeffrey W Clark
- Department of Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Bennett KH, Khor BY, Hughes S, Patel AJ. A multi-lesional analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a single-centre analysis. Clin Radiol 2024; 79:413-419. [PMID: 38378386 DOI: 10.1016/j.crad.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/10/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
AIM To conduct a multi-lesional computed tomography (CT) analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) patients to determine volumetric changes in lesions over 5 years. MATERIALS AND METHODS A retrospective case-note review was undertaken to identify 16 patients with histological and radiological features of DIPNECH between 2012-2021. Area and volume were calculated for 17 sets of lesions identified on high-resolution CT. Clinical data were extracted from electronic patient records, which included demographic data, outpatient clinic letters, histology reports, and imaging reports. RESULTS One hundred and twenty-eight lesions were identified in 16 patients (one male, 15 female) and followed-up annually over a median 1,985 days (range 1,450-2,290). At year 1 follow-up, lesion area ranged from 1-48 mm2, and lesion volume ranged from 8-18,380 mm3; lesion area ranged from 1-45mm2 and lesion volume ranged from 11-17,800 mm3 and year 5. Half (8/16) of the patients had concomitant typical carcinoid tumours and one patient had an atypical carcinoid tumour. No statistically significant correlation (p<0.05) was found between lesion cross-sectional area or volume and duration of follow-up (years and days). No metastatic spread was observed at the time of analysis. CONCLUSIONS No significant increase was observed in the size of over 100 lesions in patients with DIPNECH over a 5-year period and no metastasis occurred during the study period affirming the relatively indolent course of the disease.
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Affiliation(s)
- K H Bennett
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - B Y Khor
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - S Hughes
- Department of Nuclear Medicine and Radiology, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - A J Patel
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK; Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Bellegarde SB, Gibson V, Andaz S, Purrazella R, Robinson E, Noel P, Punter L, Tofuah D, Gapizov A, Ekhator C. Rare Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) Finding in a 9/11 World Trade Center Survivor: A Case Report. Cureus 2024; 16:e51862. [PMID: 38327919 PMCID: PMC10848887 DOI: 10.7759/cureus.51862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Bronchial carcinoid tumors represent a relatively uncommon category within lung neoplasms, originating from neuroendocrine cells. The exact cause of these pulmonary tumors remains not fully understood. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is characterized by widespread hyperplasia of these neuroendocrine cells, essential for regulating air and blood flow in response to stimuli such as hypoxia, dyspnea, and chronic obstructive pulmonary disease (COPD). The prognosis for bronchial carcinoid tumors hinges on factors such as grade and stage, with lung resection being the preferred treatment. A chest computed tomography (CT) scan unveiled diffuse bilateral pulmonary nodules with ground-glass opacities, leading to a right video-assisted thoracoscopic surgery (VATS) wedge resection. Immunohistochemical examination confirmed neuroendocrine differentiation, describing a lung wedge measuring 9 × 4 × 1.5 cm with spongy parenchyma and scattered white nodules.
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Affiliation(s)
- Sophia B Bellegarde
- Pathology and Laboratory Medicine, American University of Antigua, St. John's, ATG
| | - Vanessa Gibson
- Thoracic Surgery, Mount Sinai South Nassau, Oceanside, USA
| | | | | | | | - Pharlin Noel
- Surgery, Mount Sinai South Nassau, Oceanside, USA
| | - Lauren Punter
- Pathology, American University of Antigua, St. John's, ATG
| | | | - Abubakar Gapizov
- General Surgery, American University of Antigua, St. John's, ATG
| | - Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
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Babalola O, Muskrat J, Kanchustambham V. Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) Progressing to Carcinoid Tumor: A Case of Chronic Cough. Cureus 2023; 15:e46659. [PMID: 37942391 PMCID: PMC10628604 DOI: 10.7759/cureus.46659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH), a rare disease previously overlooked, is gradually being recognized as an important precursor state to pulmonary neuroendocrine tumors. The very insidious onset of symptom presentation makes early diagnosis of DIPNECH almost impossible in clinical settings. In this report, we present a case of persistent and worsening cough for over five years with waxing and waning lung nodules of varying sizes which were eventually diagnosed as DIPNECH on biopsy. However, due to the location and the multiplicity of these nodules, surgical resection was not an option in this case. The diagnostic workup including imaging and biopsy, management options, and possible prognosis of DIPNECH are discussed in detail. This report highlights the growing recognition of DIPNECH as a clinical entity to be aware of during the formulation of a differential diagnosis for patients presenting with chronic unrelenting cough and associated lung nodules.
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Affiliation(s)
- Olawale Babalola
- Pulmonology, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Judge Muskrat
- Pulmonology, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
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Castillón JC, Gordoa TA, Bayonas AC, Carretero AC, García-Carbonero R, Pulido EG, Fonseca PJ, Lete AL, Huerta AS, Plazas JG. SEOM-GETNE clinical guidelines for the diagnosis and treatment of gastroenteropancreatic and bronchial neuroendocrine neoplasms (NENs) (2022). Clin Transl Oncol 2023; 25:2692-2706. [PMID: 37204633 PMCID: PMC10425298 DOI: 10.1007/s12094-023-03205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
Neuroendocrine neoplasms (NENs) are a heterogeneous family of tumors of challenging diagnosis and clinical management. Their incidence and prevalence continue to rise mainly due to an improvement on diagnostic techniques and awareness. Earlier detection, along with steadfast improvements in therapy, has led to better prognosis over time for advanced gastrointestinal and pancreatic neuroendocrine tumors. The aim of this guideline is to update evidence-based recommendations for the diagnosis and treatment of gastroenteropancreatic and lung NENs. Diagnostic procedures, histological classification, and therapeutic options, including surgery, liver-directed therapy, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, are reviewed and discussed, and treatment algorithms to guide therapeutic decisions are provided.
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Affiliation(s)
- Jaume Capdevila Castillón
- Servicio de Oncología Médica, Hospital Universitario Vall D’Hebron, Ps Vall d’Hebron, 119-129, 08035 Barcelona, Spain
| | - Teresa Alonso Gordoa
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | | | - Paula Jiménez Fonseca
- Servicio de Oncología Médica, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Angela Lamarca Lete
- Servicio de Oncología Médica, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Angel Segura Huerta
- Servicio de Oncología Médica, Hospital Universitari I Politècnic la Fe, Valencia, Spain
| | - Javier Gallego Plazas
- Servicio de Oncología Médica, Hospital General Universitario de Elche, Alicante, Spain
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Jha T, Sharma A, Kalakkunath S, Mullick S. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: an under-recognized entity-a report of two cases. Indian J Thorac Cardiovasc Surg 2023; 39:407-411. [PMID: 37346440 PMCID: PMC10279627 DOI: 10.1007/s12055-023-01506-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 06/23/2023] Open
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary disorder that is classified as a pre-invasive lesion. It can also be present in association with chronic lung diseases. We present two cases of DIPNECH, which were picked up incidentally only on histopathology. A 29-year-old male presented with a history of longstanding cough with expectoration. A computed tomography (CT) scan showed bronchiectasis in the left lung. Histopathological evaluation of the pneumonectomy specimen revealed nests of proliferating, non-infiltrating neuroendocrine cells. Our second patient was a 38-year-old female with chronic cough and expectoration with recent exacerbation. CT scan showed cystic bronchiectasis in the left lower lobe; hence, a lobectomy was performed. On histopathology, nests of non-infiltrating neuroendocrine cells were noted. A diagnosis of DIPNECH with bronchiectasis was offered to both patients, and they have been on follow-up ever since. DIPNECH is a diagnostic and therapeutic quandary requiring a high index of suspicion for its detection and effective surveillance.
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Affiliation(s)
- Tanvi Jha
- Department of Pathology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, 110030 India
| | - Anil Sharma
- Department of Pathology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, 110030 India
| | - Sankar Kalakkunath
- Department of Pathology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, 110030 India
| | - Shalini Mullick
- Department of Pathology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, 110030 India
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Well-Differentiated Bronchopulmonary Neuroendocrine Tumors: More Than One Entity. J Thorac Oncol 2021; 16:1810-1820. [PMID: 34352379 DOI: 10.1016/j.jtho.2021.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/21/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Until now, well-differentiated bronchopulmonary neuroendocrine tumors (bpNET) occurring either sporadically (sp-bpNET) or in the context of multiple endocrine neoplasia type 1 (MEN1) and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) are regarded as similar entities. However, in contrast to sp-bpNET: MEN1-related and DIPNECH-related bpNET rarely metastasize or lead to bpNET-related death. We aimed to describe and compare the course of the disease of sp-bpNET, DIPNECH- and MEN1-related bpNET. METHODS All patients with histologically confirmed MEN1-related bpNET from the DutchMEN Study Group database (1990-2017), patients with resected sp-bpNET and DIPNECH patients referred to a Dutch European Neuroendocrine Tumor Society center between 2000 and 2018 were included. Fisher's exact test was used for comparison between groups. The primary end point was disease-specific mortality (DSM). Kaplan-Meier and logrank test were used to compare survival. Cox regression was used to identify risk factors for DSM in the sp-bpNET subgroup. RESULTS We included 112 sp-bpNET, 29 MEN1, and 27 DIPNECH patients. Tumor classification was similar across subgroups. A total of 20 patients (18%) with sp-bpNET died because of bpNET, compared with none in the MEN1 group and DIPNECH group. Median disease-specific survival was 12.3 (confidence interval: 6.3-18.3) years for patients with sp-bpNET, and not estimable for the other subgroups (p < 0.001). Differences in baseline characteristics did not explain worse survival in sp-bpNET. Tumor classification and age at diagnosis were independent risk factors for DSM in sp-bpNET. CONCLUSIONS Patients with sp-bpNET have a significantly higher DSM compared with MEN1 or DIPNECH-related bpNET, unexplained by differences in baseline characteristics. This implies that not all bpNET are similar entities.
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Balinotti JE, Maffey A, Colom A, Roldán O, Díaz W, Medín M, Racimo M, Teper A. Clinical, functional, and computed tomography findings in a cohort of patients with neuroendocrine cell hyperplasia of infancy. Pediatr Pulmonol 2021; 56:1681-1686. [PMID: 33580744 DOI: 10.1002/ppul.25319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/16/2021] [Accepted: 02/09/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Neuroendocrine cell hyperplasia of infancy (NEHI) is one of the most common interstitial lung diseases in children. Both the etiology and pathophysiological mechanisms of the disease are still unknown. Prognosis is usually favorable; however, there are significant morbidities during the early years of life. OBJECTIVE To describe the clinical course, infant pulmonary function tests and computed tomography (CT) findings in a cohort of patients with NEHI in Argentina. METHODS This is a observational multicenter cohort study of children diagnosed with NEHI between 2011 and 2020. RESULTS Twenty patients participated in this study. The median age of onset of symptoms was 3 months and the median age at diagnosis was 6 months. The most common clinical presentation was tachypnea, retractions and hypoxemia. The chest CT findings showed central ground glass opacities and air trapping. Infant pulmonary function tests revealed an obstructive pattern in 75% of the cases (10/12). Most patients (75%) required home oxygen therapy for 17 months (interquartile range 12-25). In 85% of them, tachypnea and hypoxemia spontaneously resolved between the second and third years of life. CONCLUSION In this cohort, the first symptoms appeared during the early months of life. The typical clinical, CT, and functional findings allowed the diagnosis without the need of a lung biopsy. Although most patients required home oxygen therapy, they showed a favorable evolution.
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Affiliation(s)
- Juan E Balinotti
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Alberto Maffey
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Alejandro Colom
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Oscar Roldán
- Division of Pediatric, Sanatorio del Salvador, Córdoba, Argentina
| | - Walter Díaz
- Division of Pediatric, Alexander Fleming Hospital, Mendoza, Argentina
| | - Martín Medín
- Department of Pathology, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Mariano Racimo
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Alejandro Teper
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
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Brouns I, Verckist L, Pintelon I, Timmermans JP, Adriaensen D. Pulmonary Sensory Receptors. ADVANCES IN ANATOMY EMBRYOLOGY AND CELL BIOLOGY 2021; 233:1-65. [PMID: 33950466 DOI: 10.1007/978-3-030-65817-5_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Inge Brouns
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerpen (Wilrijk), Belgium.
| | - Line Verckist
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerpen (Wilrijk), Belgium
| | - Isabel Pintelon
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerpen (Wilrijk), Belgium
| | - Jean-Pierre Timmermans
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerpen (Wilrijk), Belgium
| | - Dirk Adriaensen
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerpen (Wilrijk), Belgium
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10
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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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Schwartzstein RM, Medoff BD, Sharma A, Colson YL, Gainor J, Hariri LP. Case 4-2021: A 70-Year-Old Woman with Dyspnea on Exertion and Abnormal Findings on Chest Imaging. N Engl J Med 2021; 384:563-574. [PMID: 33567196 DOI: 10.1056/nejmcpc2027088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Richard M Schwartzstein
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
| | - Benjamin D Medoff
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
| | - Amita Sharma
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
| | - Yolonda L Colson
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
| | - Justin Gainor
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
| | - Lida P Hariri
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
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van den Broek MFM, de Laat JM, van Leeuwaarde RS, van de Ven AC, de Herder WW, Dekkers OM, Drent ML, Kerstens MN, Bisschop PH, Havekes B, Hackeng WM, Brosens LAA, Vriens MR, Buikhuisen WA, Valk GD. The Management of Neuroendocrine Tumors of the Lung in MEN1: Results From the Dutch MEN1 Study Group. J Clin Endocrinol Metab 2021; 106:e1014-e1027. [PMID: 33135721 DOI: 10.1210/clinem/dgaa800] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Multiple endocrine neoplasia type 1 (MEN1)-related neuroendocrine tumors (NETs) of the lung are mostly indolent, with a good prognosis. Nevertheless, cases of aggressive lung NET do occur, and therefore the management of individual patients is challenging. AIM To assess tumor growth and the survival of patients with MEN1-related lung NETs at long-term follow-up. METHODS The population-based Dutch MEN1 Study Group database (n = 446) was used to identify lung NETs by histopathological and radiological examinations. Tumor diameter was assessed. Linear mixed models and the Kaplan-Meier method were used for analyzing tumor growth and survival. Molecular analyses were performed on a lung NET showing particularly aggressive behavior. RESULTS In 102 patients (22.9% of the total MEN1 cohort), 164 lesions suspected of lung NETs were identified and followed for a median of 6.6 years. Tumor diameter increased 6.0% per year. The overall 15-year survival rate was 78.0% (95% confidence interval: 64.6-94.2%) without lung NET-related death. No prognostic factors for tumor growth or survival could be identified. A somatic c.3127A > G (p.Met1043Val) PIK3CA driver mutation was found in a case of rapid growing lung NET after 6 years of indolent disease, presumably explaining the sudden change in course. CONCLUSION MEN1-related lung NETs are slow growing and have a good prognosis. No accurate risk factors for tumor growth could be identified. Lung NET screening should therefore be based on well-informed, shared decision-making, balancing between the low absolute risk of an aggressive tumor in individuals and the potential harms of frequent thoracic imaging.
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Affiliation(s)
- Medard F M van den Broek
- Department of Endocrine Oncology, University Medical Center Utrecht, GA Utrecht, The Netherlands
| | - Joanne M de Laat
- Department of Endocrine Oncology, University Medical Center Utrecht, GA Utrecht, The Netherlands
- Department of Internal Medicine, University Medical Center Utrecht, GA Utrecht, The Netherlands
| | - Rachel S van Leeuwaarde
- Department of Endocrine Oncology, University Medical Center Utrecht, GA Utrecht, The Netherlands
| | - Annenienke C van de Ven
- Department of Endocrinology, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - Wouter W de Herder
- Department of Internal Medicine, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology and Metabolism, Leiden University Medical Center, RC Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, RC Leiden, The Netherlands
| | - Madeleine L Drent
- Department of Internal Medicine, Section of Endocrinology, Amsterdam UMC, location VU University Medical Center, MB Amsterdam, The Netherlands
| | - Michiel N Kerstens
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, RB Groningen, The Netherlands
| | - Peter H Bisschop
- Department of Endocrinology and Metabolism, Amsterdam UMC, location Academic Medical Center, DD Amsterdam, The Netherlands
| | - Bas Havekes
- Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center, AZ Maastricht, The Netherlands
| | - Wenzel M Hackeng
- Department of Pathology, University Medical Center Utrecht, GA Utrecht, The Netherlands
| | - Lodewijk A A Brosens
- Department of Pathology, University Medical Center Utrecht, GA Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, GA Utrecht, The Netherlands
| | - Wieneke A Buikhuisen
- Department of Thoracic Oncology, The Netherlands Cancer Institute, BE Amsterdam, The Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, GA Utrecht, The Netherlands
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13
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Wu Y, Zhang K, Wu W, Li X, Zhang J, Chen H. Rare diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: one case report and literature review. Transl Cancer Res 2020; 9:7657-7661. [PMID: 35117365 PMCID: PMC8798407 DOI: 10.21037/tcr-20-1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 10/30/2020] [Indexed: 11/13/2022]
Abstract
Rare diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) was first diagnosed in the early 1950s, but was not fully recognized and named until 1992. Literatures reported that DIPNECH usual was multiple and diffuse bilateral nodules, rare patients demonstrate the single nodule or ground glass nodule (GGN). We diagnosed one patient because of intermittent dry cough at least one year, Chest computed tomography (CT) found a purity GGN (pGGN) in the anterior segment, right upper lung lobe, and bronchoscopy didn’t have any tumor in the bronchus in 2014. Continue follow-up 4 years, the nodule enlarged and became a mixed GGN (mGGN) in 2018 on chest CT. A diagnostics video-assisted thoracotomy with wedge resection in right upper lung lobe was performed. The pathology revealed that it was filled with neuroendocrine differentiation cells without penetration terminal bronchiole submucosal layer, immunohistochemical (IHC) staining were positive for CD-56, Cg-A, TTF, Syn and ki-67 (about 5%), leading to diagnosis of DIPNECH. A regular review of the chest CT showed no signs of tumor recurrence postoperative more than 1 year every 6 months, and we will continue follow-up. In conclusion, DIPNECH keeps stable evolution over several years, which is misdiagnosed and underdiagnosed usually. Patient who showed GGN on chest CT and had cough, dyspnea, wheezing, less frequently hemoptysis and so on, we should think of DIPNECH. Diagnosis depended on pathology and IHC staining, regular follow-up will lead to patient a long-term survival postoperative.
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Affiliation(s)
- Yonghui Wu
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai Zhang
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weibin Wu
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaojun Li
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian Zhang
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huiguo Chen
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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14
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Briganti V, Cuccurullo V, Berti V, Di Stasio GD, Linguanti F, Mungai F, Mansi L. 99mTc-EDDA/HYNIC-TOC is a New Opportunity in Neuroendocrine Tumors of the Lung (and in other Malignant and Benign Pulmonary Diseases). Curr Radiopharm 2020; 13:166-176. [PMID: 31886756 PMCID: PMC8193811 DOI: 10.2174/1874471013666191230143610] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/11/2019] [Accepted: 11/11/2019] [Indexed: 12/25/2022]
Abstract
Neuroendocrine tumors (NETs) consist of a relatively rare spectrum of malignancies that can arise from neuroendocrine cells; lung NETs (L-NETs) represent about 25% of primary lung neoplasm and 10% of all carcinoid tumors. Diagnostic algorithm usually takes into consideration chest Xray, contrast-enhanced CT and MRI. Nuclear medicine plays a crucial role in the detection and correct assessment of neoplastic functional status as it provides in vivo metabolic data related to the overexpression of Somatostatin Receptors (SSTRs) and also predicting response to peptide receptor radionuclide therapy (PRRT). 111In-Pentreotide (Octreoscan®) is commercially available for imaging of neuroendocrine tumors, their metastases and the management of patients with NETs. More recently, 99mTc-EDDA/HYNIC-TOC(Tektrotyd®) was introduced into the market and its use has been approved for imaging of patients with L-NETs and other SSTR-positive tumors. 99mTc-EDDA/HYNIC-TOC could also represent a good alternative to 68Ga-DOTA-peptides (DOTA-TOC, DOTA-NOC, DOTATATE) in hospitals or centers where PET/CT or 68Ge/68Ga generators are not available. When compared to 111In-Pentetreotide, Tektrotyd® showed slightly higher sensitivity, in the presence of higher imaging quality and lower radiation exposure for patients. Interesting perspectives depending on the kinetic analysis allowed by Tektrotyd® may be obtained in differential diagnosis of non-small cells lung cancer (NSCLC) versus small cells lung cancer (SCLC) and NETs. An interesting perspective could be also associated with a surgery radio-guided by Tektrotyd® in operable lung tumors, including either NETs and NSCLC.
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Affiliation(s)
| | - Vincenzo Cuccurullo
- Address correspondence to this author at the Medicina Nucleare, Università della Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Napoli, Italy; E-mail:
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15
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Sami R, Mahzoni P, Rezaei M. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia in a young man with hypoxia: a case report and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:560-562. [PMID: 31910184 PMCID: PMC7233775 DOI: 10.23750/abm.v90i4.7413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare lung disease, which usually affects older women. This disease is often asymptomatic. For patients who are symptomatic, symptoms usually include cough and dyspnea. In this paper, we reported a 38-year-old man who suffered from chest pain for 3 months. CT scan findings revealed scattered nodules that were less than 1 cm. Spirometry was normal and the arterial oxygen saturation at room air was 85%. Open lung biopsy revealed DIPNECH. Patients with DIPNECH are mainly elderly women with symptoms including cough and dyspnea. However, we reported a young man with chest pain and hypoxia without dyspnea. DIPNECH can occur in male and female individuals at any age. (www.actabiomedica.it)
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Affiliation(s)
- Ramin Sami
- Isfahan University of Medical Science, Isfahan, Iran.
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16
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Alrajhi NN, Paramasivam MP, Alboukai AA, Alrikabi AC, Alhamad EH. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: Unusual presentation. Ann Thorac Med 2019; 14:161-163. [PMID: 31007769 PMCID: PMC6467018 DOI: 10.4103/atm.atm_159_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 06/14/2018] [Indexed: 12/02/2022] Open
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNEC) is an abnormal proliferation of pulmonary neuroendocrine cells that occur without underlying etiology. Here, we report a unique case of 55-year-old female with unusual presentation of DIPNECH and thymoma and on the background history of Crohn's disease that might point toward an autoimmune phenomenon. To the best of our knowledge, there were no previous reports of DIPNECH with either thymoma or Crohn's disease. DIPNECH has premalignant potential and reported in association with carcinoid and non-small cell lung cancer; however, its autoimmune association never reported. The presence of multiple lung nodules along with evidence of small airway disease should alert the physician to include DIPNECH as part of the differential diagnosis given its malignant potential. The prognosis is variable and depends on the presence or absence of underlying malignancy as well as the severity of airflow obstruction.
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Affiliation(s)
- Nuha Nasser Alrajhi
- Department of Medicine, Division of Pulmonary, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Muthurajan P. Paramasivam
- Department of Medicine, Division of Pulmonary, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Amer Alboukai
- Department of Radiology, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ammar C. Alrikabi
- Department of Pathology, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Esam Hamad Alhamad
- Department of Medicine, Division of Pulmonary, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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17
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Garg A, Sui P, Verheyden JM, Young LR, Sun X. Consider the lung as a sensory organ: A tip from pulmonary neuroendocrine cells. Curr Top Dev Biol 2019; 132:67-89. [PMID: 30797518 DOI: 10.1016/bs.ctdb.2018.12.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
While the lung is commonly known for its gas exchange function, it is exposed to signals in the inhaled air and responds to them by collaborating with other systems including immune cells and the neural circuit. This important aspect of lung physiology led us to consider the lung as a sensory organ. Among different cell types within the lung that mediate this role, several recent studies have renewed attention on pulmonary neuroendocrine cells (PNECs). PNECs are a rare, innervated airway epithelial cell type that accounts for <1% of the lung epithelium population. They are enriched at airway branch points. Classical in vitro studies have shown that PNECs can respond to an array of aerosol stimuli such as hypoxia, hypercapnia and nicotine. Recent in vivo evidence suggests an essential role of PNECs at neuroimmunomodulatory sites of action, releasing neuropeptides, neurotransmitters and facilitating asthmatic responses to allergen. In addition, evidence supports that PNECs can function both as progenitor cells and progenitor niches following airway epithelial injury. Increases in PNECs have been documented in a large array of chronic lung diseases. They are also the cells-of-origin for small cell lung cancer. A better understanding of the specificity of their responses to distinct insults, their impact on normal lung function and their roles in the pathogenesis of pulmonary ailments will be the next challenge toward designing therapeutics targeting the neuroendocrine system in lung.
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Affiliation(s)
- Ankur Garg
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
| | - Pengfei Sui
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
| | - Jamie M Verheyden
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
| | - Lisa R Young
- Division of Pulmonary Medicine, Center for Childhood Lung Research, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Xin Sun
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States; Department of Biological Sciences, University of California, San Diego, La Jolla, CA, United States.
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