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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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Gutierrez M, Alonso A, Penha D, Ntouskou M, Gosney J, Radike M. Radiological-pathological correlation in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH): imaging and histopathology. Clin Radiol 2024; 79:133-141. [PMID: 37945436 DOI: 10.1016/j.crad.2023.10.013] [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: 06/05/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 11/12/2023]
Abstract
AIM To review histologically confirmed diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) cases and carry out a detailed pathological-radiological correlation to see if computed tomography (CT) can be used to confidently identify DIPNECH. MATERIALS AND METHODS Twenty-three histologically confirmed DIPNECH patients in the shared database of two NHS Trusts were reviewed. CT images were reviewed by two independent radiologists, each of them with >10 years of experience in thoracic imaging. All histological specimens were reviewed by a single pathologist with >25 years of experience. The diagnosis of DIPNECH was made according to the current World Health Organization (WHO) definition included in the WHO 2015 classification of pulmonary tumours. The results on histology were compared to the presence of nodules and air trapping on CT. Demographic information and, when available, molecular imaging studies and pulmonary function tests were also considered. RESULTS There are prototypal clinical and radiological findings reflecting the presence of underlying histological DIPNECH: middle-aged women with multiple small and scattered nodules due to the clustering and proliferation of neuroendocrine cells. At least one larger, dominant, lung nodule reflecting a carcinoid tumour is very common and mosaic attenuation/air trapping is seen approximately in 50% of cases in inspiratory scans. Airflow obstruction is rarely associated with histological bronchial or peribronchial fibrosis, which suggests other mechanisms must be involved in its development. CONCLUSION CT can be used to predict pathological DIPNECH in the appropriate clinical setting. It is important to consider DIPNECH to avoid overdiagnosis of more sinister conditions such as lung cancer or metastases.
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Affiliation(s)
- M Gutierrez
- Department of Radiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
| | - A Alonso
- Department of Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Penha
- Department of Radiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - M Ntouskou
- Department of Radiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - J Gosney
- Cellular Pathology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - M Radike
- Department of Radiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
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Self A, Afshar K, Kafi A, Yung G, Golts E, Lin CM. An Unexpected Cause of Lung Disease Identified After Lung Transplantation. Chest 2023; 164:e111-e115. [PMID: 37805248 DOI: 10.1016/j.chest.2023.04.041] [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: 03/31/2023] [Accepted: 04/25/2023] [Indexed: 10/09/2023] Open
Abstract
CASE PRESENTATION A 54-year-old woman with systemic lupus erythematosus with associated interstitial lung disease (ILD) presented to the lung transplant clinic for assessment of candidacy for transplantation. She was initially diagnosed with ILD based on clinical and radiographic features (never underwent lung biopsy). In addition, she had associated mixed group I/III pulmonary arterial hypertension. The patient had no family history of pulmonary disease and had never used tobacco and did not have a history of illicit drug use. She was maintained on systemic immunosuppression with hydroxychloroquine, mycophenolate mofetil, and nintedanib for ILD as well as inhaled treprostinil, sildenafil, and macitentan for pulmonary arterial hypertension. Given her progressive symptoms on maximal medical therapy, she was referred for consideration to undergo lung transplantation.
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Affiliation(s)
- Alyssa Self
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA.
| | - Kamyar Afshar
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA
| | - Aarya Kafi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA
| | - Gordon Yung
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA
| | - Eugene Golts
- Department of Surgery, Division of Cardiac and Thoracic Surgery, University of California San Diego, San Diego, CA
| | - Christine M Lin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA
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O’Brien C, Duignan JA, Gleeson M, O’Carroll O, Franciosi AN, O’Toole D, Fabre A, Crowley RK, McCarthy C, Dodd JD, Murphy DJ. Quantitative Airway Assessment of Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) on CT as a Novel Biomarker. Diagnostics (Basel) 2022; 12:diagnostics12123096. [PMID: 36553103 PMCID: PMC9776594 DOI: 10.3390/diagnostics12123096] [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] [Received: 11/21/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) occurs due to abnormal proliferation of pulmonary neuroendocrine cells. We hypothesized that performing a quantitative analysis of airway features on chest CT may reveal differences to matched controls, which could ultimately help provide an imaging biomarker. Methods: A retrospective quantitative analysis of chest CTs in patients with DIPNECH and age matched controls was carried out using semi-automated post-processing software. Paired segmental airway and artery diameters were measured for each bronchopulmonary segment, and the airway:artery (AA) ratio, airway wall thickness:artery ratio (AWTA ratio) and wall area percentage (WAP) calculated. Nodule number, size, shape and location was recorded. Correlation between CT measurements and pulmonary function testing was performed. Results: 16 DIPNECH and 16 control subjects were analysed (all female, mean age 61.7 +/− 11.8 years), a combined total of 425 bronchopulmonary segments. The mean AwtA ratio, AA ratio and WAP for the DIPNECH group was 0.57, 1.18 and 68.8%, respectively, compared with 0.38, 1.03 and 58.3% in controls (p < 0.001, <0.001, 0.03, respectively). DIPNECH patients had more nodules than controls (22.4 +/− 32.6 vs. 3.6 +/− 3.6, p = 0.03). AA ratio correlated with FVC (R2 = 0.47, p = 0.02). A multivariable model incorporating nodule number, AA ratio and AWTA-ratio demonstrated good performance for discriminating DIPNECH and controls (AUC 0.971; 95% CI: 0.925−1.0). Conclusions: Quantitative CT airway analysis in patients with DIPNECH demonstrates increased airway wall thickness and airway:artery ratio compared to controls. Advances in knowledge: Quantitative CT measurement of airway wall thickening offers a potential imaging biomarker for treatment response.
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Affiliation(s)
- Cormac O’Brien
- Department of Radiology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- National Centre for Neuroendocrine Tumours, ENETS NET Centre of Excellence, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - John A. Duignan
- Department of Radiology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Margaret Gleeson
- Department of Respiratory Medicine, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Orla O’Carroll
- Department of Respiratory Medicine, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Alessandro N. Franciosi
- Department of Respiratory Medicine, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Dermot O’Toole
- National Centre for Neuroendocrine Tumours, ENETS NET Centre of Excellence, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Aurelie Fabre
- National Centre for Neuroendocrine Tumours, ENETS NET Centre of Excellence, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- Department of Pathology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Rachel K. Crowley
- National Centre for Neuroendocrine Tumours, ENETS NET Centre of Excellence, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
- Department of Endocrinology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Jonathan D. Dodd
- Department of Radiology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - David J. Murphy
- Department of Radiology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- National Centre for Neuroendocrine Tumours, ENETS NET Centre of Excellence, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
- Correspondence: ; Tel.: +353-1-221400
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Muacevic A, Adler JR, Mahathevan K. Pulmonary Function Tests as a Biomarker in Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia Patients Treated With Somatostatin Analogues. Cureus 2022; 14:e32454. [PMID: 36644074 PMCID: PMC9834669 DOI: 10.7759/cureus.32454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) describes an indolent, under-recognised and poorly understood pulmonary condition with fewer than 200 reported cases across the literature. Currently, cases are diagnosed following a biopsy of the primary lesion, with treatment options centring on symptomatic benefit as opposed to targeting the underlying aetiology. Classically, DIPNECH lesions have been described as slow growing and benign, but with growing awareness of the condition, reports of metastatic disease with significant symptomatic burden have been reported. However, effectively addressing the subset of DIPNECH patients with greater metastatic potential remains an unmet clinical need. Due to the similarities between DIPNECH and carcinoid patients, several centres have considered using somatostatin analogues to not only help symptomatically but also to initiate tumour regression. However, to date, there are limited biomarkers to help evaluate the benefit of such options. In this review, we consider the use of pulmonary function tests (PFTs) to help quantify the benefit of somatostatin analogues. Although much of the evidence stems from small single-centre studies, the use of PFTs within the treatment pathway for both localised and metastatic DIPNECH represents a meaningful improvement from subjective monitoring of disease.
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Hurabielle C, Taillé C, Prévot G, Russier M, Didier A, Girodet PO, Colombat M, Mazières J, Guilleminault L. De-labeling severe asthma diagnosis: the challenge of DIPNECH. ERJ Open Res 2022; 8:00485-2021. [PMID: 35211620 PMCID: PMC8864625 DOI: 10.1183/23120541.00485-2021] [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: 08/23/2021] [Accepted: 12/12/2021] [Indexed: 11/20/2022] Open
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary disease characterised by neuroendocrine cell hyperplasia within the bronchial epithelium [1]. The clinical presentation is characterised by nonspecific respiratory symptoms such as chronic cough, dyspnoea and bronchospasm. Given the rarity of the disease and the low specificity of symptoms, the diagnosis of DIPNECH is challenging and the time between symptom onset and diagnosis is long [1]. DIPNECH comprises a generalised proliferation of scattered neuroendocrine cells, small nodules (neuroendocrine bodies) or a linear proliferation of pulmonary neuroendocrine cells. It has been suggested that DIPNECH may mimic [2] or precede [3] asthma. The role of products of neuroendocrine cells such as substance P, which contribute to eosinophil migration, has been suggested to explain asthma symptoms in DIPNECH [3]. However, the characteristics of patients with DIPNECH who have symptoms suggestive of asthma have never been described. The aim of our study was to determine whether patients diagnosed with DIPNECH and initially referred for severe asthma management had specific characteristics. DIPNECH is a differential diagnosis of severe asthma with no specific biomarkers. Chronic cough and multiple nodules on CT should prompt clinicians to consider this diagnosis. Differentiating DIPNECH from severe asthma remains crucial.https://bit.ly/3mmFbQn
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Samhouri BF, Koo CW, Yi ES, Ryu JH. Is the combination of bilateral pulmonary nodules and mosaic attenuation on chest CT specific for DIPNECH? Orphanet J Rare Dis 2021; 16:490. [PMID: 34809674 PMCID: PMC8607646 DOI: 10.1186/s13023-021-02103-w] [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: 07/07/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is characterized by multifocal proliferation of pulmonary neuroendocrine cells. On chest CT, DIPNECH exhibits bilateral pulmonary nodules and mosaic attenuation in most patients. We sought to: (1) assess the specificity of this pattern (i.e., bilateral pulmonary nodules together with mosaic attenuation) for DIPNECH; (2) describe its differential diagnosis; and (3) identify the clinico-radiologic features that may help prioritize DIPNECH over other diagnostic considerations. Methods We searched the Mayo Clinic records from 2015 to 2019 for patients with bilateral pulmonary nodules and mosaic attenuation on CT who had a diagnostic lung biopsy. A thoracic radiologist reviewed all CT scans. Chi-square test was used for categorical variables, and odds ratios were utilized to measure the association between certain variables and DIPNECH. Results Fifty-one patients met our inclusion criteria; 40 (78%) were females and 34 (67%) were never-smokers. Median age was 65 (interquartile range 55–73) years. Lung biopsy was surgical in 21 patients (41%), transbronchial in 17 (33%), and transthoracic in 12 (24%); explanted lungs were examined in 1 (2%). Metastatic/multifocal cancer was the most common diagnosis, and was found in 17 (33%) cases. Bronchiolitis was diagnosed in 12 patients (24%), interstitial lung disease in 10 (20%), and DIPNECH in 5 (10%). Previous diagnosis of an obstructive lung disease (odds ratio 15.8; P = 0.002), and peribronchial nodular distribution on CT (odds ratio 14.4; P = 0.006) were significantly correlated with DIPNECH. Although statistical significance was not reached, DIPNECH nodules were more likely to display solid attenuations (80% vs. 67%, P = 0.45), and were more numerous; > 10 nodules were seen in 80% of DIPNECH cases vs. 52% in others (P = 0.23). Because DIPNECH primarily affects women, we analyzed the women-only cohort and found similar results. Conclusions Various disorders can manifest the CT pattern of bilateral pulmonary nodules together with mosaic attenuation, and this combination is nonspecific for DIPNECH, which was found in only 10% of our cohort. Previous diagnosis of an obstructive lung disease, and peribronchial distribution of the nodules on CT increased the likelihood of DIPNECH vs. other diagnoses. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02103-w.
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Affiliation(s)
- Bilal F Samhouri
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Gonda 18 South, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Chi Wan Koo
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Gonda 18 South, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Distribution, shape, and immunohistochemical characteristics of serotonin-immunoreactive neuroendocrine cells in the urethra and periurethral genital organs in mice. J Mol Histol 2021; 52:1205-1214. [PMID: 34637009 DOI: 10.1007/s10735-021-10020-2] [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: 03/01/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
The aim of this study is to clarify the disibution, shape, and immunohistochemical characteristics of serotonin-immunoreactive neuroendocrine cells (SIR-NECs) in mouse prostate and in the surrounding genital organs by histological and immunohistochemical analysis of the light microscopic serial sections of urethra. We collected lower urinary tracts from 13-week-old mice and observed the distribution pattern and shape of the SIR-NECs by serial light microscopy. The organs on the sections were divided into three anatomical zones to clarify the distribution pattern of SIR-NECs: (1) zone A, the ducts near the prostatic urethra; (2) zone B, the ducts outside the urethral sphincter; and (3) zone C, the acinus areas. Sections were double immune-stained with antibodies against serotonin and one of neuroendocrine-related factors (NRFs), including 10 neural cell markers and eight neurotransmitters, and also 4',6-diamino-2-phenylindole (DAPI). In addition, SIR-NECs were double immune-stained with antibodies against cytokeratin 5 (CK5) and p63, together with DAPI. SIR-NECs were mostly localized in zone A, and no SIR-NECs were observed in zone C. The proportion of flask-shaped SIR-NECs was approximately 15% in zones A and B. No flask-shaped SIR-NECs were observed in urethral epithelia. The NRFs co-localized with SIR-NEC were calcitonin gene-related peptide, CD56, chromogranin A, neuron-specific enolase, neuron cytoplastic protein 9.5, and synaptophysin (72.3%, 73.2%, 88.9%, 92.3%, 91.7%, and 81.9%, respectively). CK5 and p63 were not co-localized with SIR-NECs. In this study, SIR-NEC of the urethra and the surrounding genital organs was ubiquitous in the urethra and the ducts near the urethra and co-expressed specific nerve-related NRFs.
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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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Saha BK, Bonnier A, Chong WH, Chieng H, Ibrahim A. A 75-Year-Old Woman With Pulmonary Nodules and Dyspnea. Chest 2021; 160:e51-e56. [PMID: 34246389 DOI: 10.1016/j.chest.2021.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/26/2021] [Accepted: 02/11/2021] [Indexed: 10/20/2022] Open
Abstract
CASE PRESENTATION A 75-year-old woman was referred to the pulmonary office in January 2020 for cough and progressive worsening of shortness of breath over the years. Her medical history was significant for asthma that was diagnosed approximately 10 years earlier, when she first developed dyspnea. A pre-bronchodilator spirometry at that time showed severe airflow obstruction (Fig 1). The patient was incidentally found to have several noncalcified pulmonary nodules on a chest CT scan in 2015, which was obtained as a part of dyspnea workup. She underwent bronchoscopic evaluation with transbronchial biopsy of the largest nodule (1.6 × 1.2 cm) in the right middle lobe. She was diagnosed with low-grade neuroendocrine tumor (typical carcinoid) and had been under surveillance without any progression in the number of nodules or the size of the existing nodules. She was a lifelong nonsmoker and no family history of asthma. Over the years, she received multiple courses of systemic corticosteroids and different inhalers, without any improvement in her symptoms. The patient was frustrated by the lack of perceived benefit, and she discontinued all respiratory medications. She denied any fever, night sweats, exertional chest pain, or seasonal allergies but reported cough, wheezing, and severe exertional shortness of breath. She was unable to walk more than 20 feet at a time. She had no pets at home and did not travel outside the United States. Her only home medications were multivitamins and low-dose aspirin.
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Affiliation(s)
- Biplab K Saha
- Department of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, MO.
| | - Alyssa Bonnier
- Goldfarb School of Nursing, Barnes-Jewish College, Saint Louis, MO
| | - Woon H Chong
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
| | - Hau Chieng
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
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A 72-Year-Old Woman With Multiple Pulmonary Nodules and a History of Malignancy. Chest 2021; 160:e57-e61. [PMID: 34246390 DOI: 10.1016/j.chest.2021.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/26/2021] [Accepted: 02/20/2021] [Indexed: 11/22/2022] Open
Abstract
A 72-year-old woman, nonsmoker, presented with approximately 2 months of nonproductive cough. The cough was initially intermittent, occurred more regularly during bedtime, but gradually became more frequent throughout the day with no reported triggering factors. The remaining review of associated symptoms was negative; she did not complain of shortness of breath, fever, chest pain, muscle weakness, weight loss, night sweats, or fatigue. She previously had been given a prescription of butamirate syrup and decongestant nasal spray with no response. Her medical history included successfully treated papillary thyroid cancer with total thyroidectomy 4 years ago, and there was no need for further therapy. Patient was free of disease on follow up from her endocrinologist, to optimize levothyroxine treatment. Her regular prescription included statins. Her professional occupation was not related to special exposure, and she reported no alcohol consumption, illicit drug use, or any recent travel.
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Chung C, Bommart S, Marchand-Adam S, Lederlin M, Fournel L, Charpentier MC, Groussin L, Wislez M, Revel MP, Chassagnon G. Long-Term Imaging Follow-Up in DIPNECH: Multicenter Experience. J Clin Med 2021; 10:jcm10132950. [PMID: 34209147 PMCID: PMC8268818 DOI: 10.3390/jcm10132950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022] Open
Abstract
Diffuse pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pre-invasive disease whose pathophysiology remains unclear. We aimed to assess long-term evolution in imaging of DIPNECH, in order to propose follow-up recommendations. Patients with histologically confirmed DIPNECH from four centers, evaluated between 2001 and 2020, were enrolled if they had at least two available chest computed tomography (CT) exams performed at least 24 months apart. CT exams were analyzed for the presence and the evolution of DIPNECH-related CT findings. Twenty-seven patients, mostly of female gender (n = 25/27; 93%) were included. Longitudinal follow-up over a median 63-month duration (IQR: 31–80 months) demonstrated an increase in the size of lung nodules in 19 patients (19/27, 70%) and the occurrence of metastatic spread in three patients (3/27, 11%). The metastatic spread was limited to mediastinal lymph nodes in one patient, whereas the other two patients had both lymph node and distant metastases. The mean time interval between baseline CT scan and metastatic spread was 70 months (14, 74 and 123 months). Therefore, long-term annual imaging follow-up of DIPNECH might be appropriate to encompass the heterogeneous longitudinal behavior of this disease.
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Affiliation(s)
- Cécile Chung
- Department of Radiology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France; (C.C.); (M.-P.R.)
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
| | - Sébastien Bommart
- Radiology Department, CHU Montpellier, Hôpital Arnaud de Villeneuve, 34090 Montpellier, France;
- Université de Montpellier, PHYMEDEXP-INSERM U1046-CNRS UMR 9214, 34000 Montpellier, France
| | - Sylvain Marchand-Adam
- Pulmonology Department, Université François Rabelais, CHU Tours, Hôpital Bretonneau, 37000 Tours, France;
| | - Mathieu Lederlin
- Department of Radiology, University of Rennes, University Hospital of Rennes, 35033 Rennes, France;
| | - Ludovic Fournel
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Thoracic Surgery Department, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France
| | | | - Lionel Groussin
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Department of Endocrinology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France
| | - Marie Wislez
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Oncology Thoracic Unit Pulmonology Department, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France
- Université de Paris, Centre de Recherche des Cordeliers, Inserm, «Inflammation, Complement, and Cancer», 75006 Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France; (C.C.); (M.-P.R.)
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
| | - Guillaume Chassagnon
- Department of Radiology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France; (C.C.); (M.-P.R.)
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Correspondence:
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Yap V, Datta D. An Older Woman With Transient Cough, Mild Airway Obstruction, and Lung Nodules. Chest 2021; 158:e111-e115. [PMID: 32892886 DOI: 10.1016/j.chest.2020.05.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/10/2020] [Accepted: 05/01/2020] [Indexed: 10/23/2022] Open
Abstract
CASE PRESENTATION A 66-year-old woman with no significant medical history presented initially to her primary care physician's office with a 2-weeks history of productive cough and associated wheezing after cough paroxysms. Empiric antibiotic was started, with no improvement. Chest radiograph was performed, which showed bilateral nodular opacities (Fig 1). The patient's cough resolved in 6 weeks after empiric treatment with oral steroids, inhaled steroids, and bronchodilators. A follow-up chest radiograph done at 6 weeks showed persistent abnormalities, and she was referred for a pulmonary evaluation. She denied any fevers, cough, hemoptysis, shortness of breath, wheezing, loss of appetite, or weight loss at that time. She had no significant medical problems and was not on any medications at that time. She was a nonsmoker. She worked in an office setting and denied any occupational or recreational exposures or recent travels. There was no family history of lung diseases or cancer.
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Affiliation(s)
- Vanessa Yap
- Division of Pulmonary & Critical Care Medicine, University of Connecticut Health Center, Farmington, CT
| | - Debapriya Datta
- Division of Pulmonary & Critical Care Medicine, University of Connecticut Health Center, Farmington, CT.
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Prieto M, Chassagnon G, Lupo A, Charpentier MC, Cabanne E, Groussin L, Wislez M, Alifano M, Fournel L. Lung carcinoid tumors with Diffuse Idiopathic Pulmonary NeuroEndocrine Cell Hyperplasia (DIPNECH) exhibit pejorative pathological features. Lung Cancer 2021; 156:117-121. [PMID: 33940544 DOI: 10.1016/j.lungcan.2021.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/02/2021] [Accepted: 04/25/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Diffuse Idiopathic Pulmonary NeuroEndocrine Cell Hyperplasia (DIPNECH) is a rare disease often associated with carcinoid tumors. We aimed at evaluating the impact of DIPNECH on characteristics and prognosis of patients who underwent radical treatment of pulmonary carcinoid tumors. MATERIAL AND METHODS We reviewed all patients operated on for curative-intent resection of carcinoid tumor in our department from 2001 to 2020. Cases exhibiting both pathological and radiological features of DIPNECH, as assessed by respective thoracic expert physicians, were analyzed separately. RESULTS 172 cases of resected carcinoid tumors were identified, including 25 (14.5 %) harboring pathological criteria of DIPNECH and radiologic features like mosaic attenuation (92.0 %), multiple nodules < 5 mm (76.0 %), and mucoid impactions (32 %). In DIPNECH patients, major pulmonary resections were usually performed (92.0 %) and resected tumors were mostly classified as pT1 (92 %). Mean Ki67 staining was 3.7 ± 5.2 %. The early postoperative period was mostly uneventful (96.0 %) and 5-year survival was 92.9 ± 6.9 %. Compared to non-DIPNECH cases, we found that patients were older (mean 65.6 ± 9.3 versus 54.1 ± 17.9, p = 0.002), more frequently female (84.0 % versus 56.5 %, p = 0.009), and exhibiting diabetes mellitus (45.8 % versus 18.5 %, p < 0.001) or hypertension (45.8 % versus 24.1 %, p = 0.039). The rate of atypical carcinoid tumors was significantly higher in DIPNECH patients (40.0 % versus 19.9 %, p = 0.027), as well as rate of mediastinal lymph-nodes involvement (pN2+) (36.0 % versus 4.1 %, p < 0.001). At multivariate analysis, only DIPNECH pattern and atypical histology were independent factors of pN2 invasion which was the only predictor of poorer prognosis on Log-Rank test. CONCLUSION Carcinoid tumors with proven DIPNECH are associated with negative pathological features and may deserve a dedicated perioperative management.
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Affiliation(s)
- Mathilde Prieto
- Department of Thoracic Surgery, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Guillaume Chassagnon
- Department of Chest Radiology, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Audrey Lupo
- Department of Pathology, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | | | - Eglantine Cabanne
- Department of Chest Radiology, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Lionel Groussin
- Department of Endocrinology, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Marie Wislez
- Department of Respiratory Medicine and Thoracic Oncology, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Ludovic Fournel
- Department of Thoracic Surgery, Hôpital Cochin, APHP.CUP, Université de Paris, France.
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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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Raso MG, Bota-Rabassedas N, Wistuba II. Pathology and Classification of SCLC. Cancers (Basel) 2021; 13:cancers13040820. [PMID: 33669241 PMCID: PMC7919820 DOI: 10.3390/cancers13040820] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Small cell lung carcinoma (SCLC), is a high-grade neuroendocrine carcinoma defined by its aggressiveness, poor differentiation, and somber prognosis. This review highlights current pathological concepts including classification, immunohistochemistry features, and differential diagnosis. Additionally, we summarize the current knowledge of the immune tumor microenvironment, tumor heterogeneity, and genetic variations of SCLC. Recent comprehensive genomic research has improved our understanding of the diverse biological processes that occur in this tumor type, suggesting that a new era of molecular-driven treatment decisions is finally foreseeable for SCLC patients. Abstract Lung cancer is consistently the leading cause of cancer-related death worldwide, and it ranks as the second most frequent type of new cancer cases diagnosed in the United States, both in males and females. One subtype of lung cancer, small cell lung carcinoma (SCLC), is an aggressive, poorly differentiated, and high-grade neuroendocrine carcinoma that accounts for 13% of all lung carcinomas. SCLC is the most frequent neuroendocrine lung tumor, and it is commonly presented as an advanced stage disease in heavy smokers. Due to its clinical presentation, it is typically diagnosed in small biopsies or cytology specimens, with routine immunostaining only. However, immunohistochemistry markers are extremely valuable in demonstrating neuroendocrine features of SCLC and supporting its differential diagnosis. The 2015 WHO classification grouped all pulmonary neuroendocrine carcinomas in one category and maintained the SCLC combined variant that was previously recognized. In this review, we explore multiple aspects of the pathologic features of this entity, as well as clinically relevant immunohistochemistry markers expression and its molecular characteristics. In addition, we will focus on characteristics of the tumor microenvironment, and the latest pathogenesis findings to better understand the new therapeutic options in the current era of personalized therapy.
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Affiliation(s)
- Maria Gabriela Raso
- Correspondence: (M.G.R.); (I.I.W.); Tel.: +1-713-834-6026 (M.G.R.); +1-713-563-9184 (I.I.W.)
| | | | - Ignacio I. Wistuba
- Correspondence: (M.G.R.); (I.I.W.); Tel.: +1-713-834-6026 (M.G.R.); +1-713-563-9184 (I.I.W.)
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Das C, Ghosh M, Mukhopadhyay M, Chatterjee S, Naskar B. Molecular profiling and utility of cell-free DNA in nonsmall carcinoma of the lung: Study in a tertiary care hospital. J Cancer Res Ther 2021; 17:1389-1396. [DOI: 10.4103/jcrt.jcrt_99_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Samhouri BF, Azadeh N, Halfdanarson TR, Yi ES, Ryu JH. Constrictive bronchiolitis in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. ERJ Open Res 2020; 6:00527-2020. [PMID: 33263057 PMCID: PMC7682710 DOI: 10.1183/23120541.00527-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/09/2020] [Indexed: 12/16/2022] Open
Abstract
Background Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is characterised by multifocal proliferation of neuroendocrine cells and belongs in the spectrum of pulmonary neuroendocrine tumours. Some patients with DIPNECH develop airflow obstruction but the relationship between the two entities remains unclear. Methods We performed a computer-assisted search of the Mayo Clinic's electronic medical records for biopsy-proven cases of DIPNECH. We extracted clinical, pulmonary function, imaging and histopathological data along with treatments and outcomes. Results Among 44 patients with DIPNECH 91% were female and the median age was 65 years (interquartile range 56–69 years); 73% were never-smokers. Overall, 38 patients (86%) had respiratory symptoms including cough (68%) and dyspnoea (30%); 45% were previously diagnosed to have asthma or COPD. Pulmonary function testing showed an obstructive pattern in 52%, restrictive pattern in 11%, mixed pattern in 9%, nonspecific pattern in 23%, and was normal in 5%. On chest computed tomography scan, 95% manifested diffuse nodules and 77% manifested mosaic attenuation. For management, 25% of patients were observed without pharmacological therapy, 55% received an inhaled bronchodilator, 41% received an inhaled corticosteroid, 32% received octreotide; systemic steroids, azithromycin, or combination chemotherapy was employed in four patients (9%). Of 24 patients with available follow-up pulmonary function tests, 50% remained stable, 33% worsened and 17% improved over a median interval of 21.3 months (interquartile range 9.7–46.9 months). Conclusion DIPNECH occurs mostly in women and manifests diffuse pulmonary nodules and mosaic attenuation on imaging. It is commonly associated with airflow obstruction due to constrictive bronchiolitis, which manifests limited response to current pharmacological therapy. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is an under-recognised cause of obstructive lung disease in women. Constrictive bronchiolitis associated with DIPNECH manifests limited response to currently employed therapies.https://bit.ly/3c3RZoe
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Affiliation(s)
- Bilal F Samhouri
- Dept of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Natalya Azadeh
- Dept of Pulmonary and Critical Care Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Eunhee S Yi
- Depts of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jay H Ryu
- Dept of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Sazonova O, Manem V, Béland C, Hamel MA, Lacasse Y, Lévesque MH, Orain M, Joubert D, Provencher S, Simonyan D, Joubert P. Development and Validation of Diffuse Idiopathic Pulmonary Neuroendocrine Hyperplasia Diagnostic Criteria. JTO Clin Res Rep 2020; 1:100078. [PMID: 34589957 PMCID: PMC8474376 DOI: 10.1016/j.jtocrr.2020.100078] [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: 05/07/2020] [Revised: 06/28/2020] [Accepted: 07/17/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Diffuse idiopathic pulmonary neuroendocrine hyperplasia (DIPNECH) is a rare condition that is likely underdiagnosed owing to the lack of established and validated diagnostic criteria. These clinical guidelines are empirical and created on the basis of a limited number of studies. This study was designed to validate the existing criteria and to identify new clinical parameters that can accurately diagnose DIPNECH. METHODS Patients with DIPNECH were identified from a cohort that underwent surgical lung resection for pulmonary carcinoids. The study cohort included a total of 105 consecutive cases with neuroendocrine lesions. Initial diagnostic predictors of DIPNECH were selected from the literature. We employed univariate and multivariate models to evaluate the association of clinical, pathologic, radiologic variables with the likelihood of DIPNECH. RESULTS Univariate analysis identified age, sex, chronic obstructive pulmonary disease diagnosis, obstructive abnormalities, pulmonary nodules, mosaicism, absolute numbers of pulmonary neuroendocrine lesions (PNELs), and the number of tumorlets as significant DIPNECH predictors (for p < 0.05). After adjustment for sampling variations, the ratio of the total number of PNELs to the number of bronchioles was found to be considerably higher in DIPNECH category. Multivariate analysis identified the total number of PNELs and multiple pulmonary nodules (>10) as independent predictors of DIPNECH. The performance of our criteria revealed an accuracy of 76% in detecting DIPNECH cases. CONCLUSIONS We proposed a set of diagnostic criteria for DIPNECH on the basis of an expert-panel approach integrating pathological features, radiology, and clinical data. Our findings will help identify DIPNECH patients, without a pathological confirmation of a neuroendocrine lesion. Before the implementation of these criteria in clinical practice, they require further validation in multi-institutional cohorts.
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Affiliation(s)
- Olga Sazonova
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Québec Heart and Lung Institute) Research Center, Laval University, Québec, Canada
| | - Venkata Manem
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Québec Heart and Lung Institute) Research Center, Laval University, Québec, Canada
| | - Chloé Béland
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Québec Heart and Lung Institute) Research Center, Laval University, Québec, Canada
| | - Marc-André Hamel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Québec Heart and Lung Institute) Research Center, Laval University, Québec, Canada
| | - Yves Lacasse
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Québec Heart and Lung Institute) Research Center, Laval University, Québec, Canada
- Department of Medicine, Université Laval, Québec, Canada
| | - Marie-Hélène Lévesque
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Québec Heart and Lung Institute) Research Center, Laval University, Québec, Canada
| | - Michèle Orain
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Québec Heart and Lung Institute) Research Center, Laval University, Québec, Canada
| | - David Joubert
- Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | - Steeve Provencher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Québec Heart and Lung Institute) Research Center, Laval University, Québec, Canada
- Department of Medicine, Université Laval, Québec, Canada
| | - David Simonyan
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Québec Heart and Lung Institute) Research Center, Laval University, Québec, Canada
| | - Philippe Joubert
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Québec Heart and Lung Institute) Research Center, Laval University, Québec, Canada
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Université Laval, Québec, Canada
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Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia: Imaging and Clinical Features of a Frequently Delayed Diagnosis. AJR Am J Roentgenol 2020; 215:1312-1320. [PMID: 33021835 DOI: 10.2214/ajr.19.22628] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess features of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) on CT, clinical presentation, and delays in radiologic and clinical diagnosis in a series of 32 patients. MATERIALS AND METHODS. Medical records of patients with DIPNECH from the years 2000-2017 were obtained from an institutional data warehouse. Inclusion criteria were an available CT examination and either a pathologic diagnosis of DIPNECH or pathologic findings of multiple carcinoid tumorlets or carcinoid tumor with CT features suggesting DIPNECH. Two thoracic radiologists with 10 and 14 years of experience reviewed CT examinations and scored cases in consensus. RESULTS. All 32 patients were women, and most had never smoked (69%). The mean age at presentation was 61 years. Symptoms included chronic cough (59%) or dyspnea (28%), and the initial clinical diagnosis was asthma in 41%. DIPNECH was clinically suspected at presentation in only one case and was mentioned by the interpreting radiologist in only 31% of cases. CT characteristics included numerous nodules with a lower zone and peribronchiolar predominance, mosaic attenuation, and nodular bronchial wall thickening. Number of nodules at least 5 mm in diameter showed strong inverse correlations with the percentage predicted for both forced vital capacity and forced expiratory volume in 1 second and a moderate inverse correlation with total lung capacity percentage predicted. In cases with a follow-up CT interval of 3 years or longer, 85% of patients showed an increase in size of the largest nodule, and 70% had an increase in size in multiple nodules. CONCLUSION. Many cases of DIPNECH are originally missed or misdiagnosed by radiologists and clinicians. Awareness of the typical clinical and imaging features of DIPNECH may prompt earlier diagnosis of this condition.
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Riley L, Sutchu S, Lu L, Urbine D. Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia: An Asthma Mimicker. Am J Med 2020; 133:e199-e200. [PMID: 31747544 DOI: 10.1016/j.amjmed.2019.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Leonard Riley
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville.
| | - Selina Sutchu
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville
| | - Li Lu
- Department of Pathology, University of Florida College of Medicine, Gainesville
| | - Daniel Urbine
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville
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Wang X, Huang R, Zhang GY, Huang YH, Zheng XR, Liu CT. [Clinical features of neuroendocrine cell hyperplasia of infancy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:257-261. [PMID: 32204763 PMCID: PMC7389597 DOI: 10.7499/j.issn.1008-8830.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To study the clinical features of neuroendocrine cell hyperplasia of infancy (NEHI) in order to provide a basis for the management of diagnosis, treatment and prognosis of children with NEHI. METHODS A retrospective analysis was performed for the clinical data of seven children with NEHI who were diagnosed and treated from January 2014 to March 2016. RESULTS Among the seven children with NEHI, there were five boys and two girls. Two children experienced tachypnea since the neonatal period, and five children developed respiratory tract symptoms within 1-6 months after birth. Of the 7 children, 6 had pulmonary crackles, 4 had hypoxemia, and 3 had gastroesophageal reflux. Lung high-resolution CT (HRCT) showed ground-glass opacities in the central region of the lungs in all children, which involved at least two lung lobes. Of the 7 children, 2 had the involvement of more than 4 lobes and 6 had air trapping. All 7 children had an improvement in clinical symptoms after two years of age. One child achieved clinical and CT remission. Four children achieved clinical remission, but still with CT changes. CONCLUSIONS NEHI often occurs in infancy, with the major clinical manifestations of persistent tachypnea, pulmonary crackles, and hypoxemia. The children with NEHI often present ground-glass opacities in the central region of the lungs and air trapping on HRCT. There is no specific treatment for this disease and most cases have a good prognosis.
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Affiliation(s)
- Xia Wang
- Department of Pediatrics, Xiangya Hospital of Central South University, Changsha 410008, China.
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Moussa Ounteini A, Aziagbe Koffi A, Rabiou S, Gbadamassi G, Efalou P, Effared B, Edingo Sheko J, Devin E, Philippe C, Dujon A, Adjoh K, Mehdaoui A. [A case of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) syndrome]. Rev Mal Respir 2019; 37:75-79. [PMID: 31901370 DOI: 10.1016/j.rmr.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION DIPNECH is a strictly histological entity according to the WHO 2015 classification and is considered to be at pre-neoplastic risk. It has been proposed that DIPNECH syndrome should be used to describe patients have clinical symptoms, an obstructive ventilatory disorder and compatible radiological abnormalities. The diagnosis is histological and usually based on a surgical lung biopsy. CASE REPORT We report the case of a 58-year-old woman with a chronic cough for over 20years who had an obstructive airway pattern on spirometry. Diagnoses of asthma and COPD had been discussed. After 7years of follow-up, the DIPNECH hypothesis was evoked on the scanning aspect of mosaic attenuation, expiratory trapping and micronodules, which was subsequently confirmed by surgical pulmonary biopsy. CONCLUSION It is necessary to consider the possibility of this rare disease in order to avoid inappropriate treatments and in the hope that future therapeutic advances (somatostatin analogs, mTOR inhibitors) improve patients' experience and the progression of respiratory function.
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Affiliation(s)
- A Moussa Ounteini
- Service de pneumologie et d'oncologie thoracique, hôpital d'Eure-Seine, 27015 Évreux cedex, France.
| | | | - S Rabiou
- Service de chirurgie thoracique, faculté de médecine, université Abdou Moumouni de Niamey, Niamey, Niger
| | - G Gbadamassi
- Service de pneumologie, CHU Sylvanus Olympio, Lomé, Togo
| | - P Efalou
- Service de pneumologie, CHU Sylvanus Olympio, Lomé, Togo
| | - B Effared
- Service d'anatomopathologie, hôpital National de Lamordé, Niamey, Niger
| | - J Edingo Sheko
- Service d'imagerie médical, hôpital d'Eure-Seine, 27015 Évreux cedex, France
| | - E Devin
- Service de pneumologie et d'oncologie thoracique, hôpital d'Eure-Seine, 27015 Évreux cedex, France
| | - C Philippe
- Cabinet d'anatomie et cytologie pathologique, 109, rue Verte, 76000 Rouen, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 950, rue de la Haie, 76230 Bois-Guillaume, France
| | - K Adjoh
- Service de pneumologie, CHU Sylvanus Olympio, Lomé, Togo
| | - A Mehdaoui
- Service de pneumologie et d'oncologie thoracique, hôpital d'Eure-Seine, 27015 Évreux cedex, France
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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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A Woman with a Breast Mass, Multiple Pulmonary Nodules, and Wheezing. Ann Am Thorac Soc 2019; 14:134-139. [PMID: 28035883 DOI: 10.1513/annalsats.201606-446cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Flint K, Ye C, Henry TL. Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) with liver metastases. BMJ Case Rep 2019; 12:12/6/e228536. [PMID: 31239319 DOI: 10.1136/bcr-2018-228536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) is a rare pulmonary disorder characterised by classic radiological findings and symptoms of obstructive lung disease. DIPNECH is considered a precursor to carcinoid tumours in the lungs. In this case, we describe a patient with years of unexplained dry cough presenting with 2 weeks of progressive nausea and vomiting, and found to have massive hepatomegaly on examination. By CT-PE, she was diagnosed with DIPNECH, and abdominal MRI revealed metastatic carcinoid tumours. Despite its non-specific presentation, DIPNECH has characteristic radiological findings of mosaic attenuation with numerous pulmonary nodules. DIPNECH requires early identification and close surveillance to prevent progression to carcinoid tumours. Thus, it is critical for frontline providers to consider this diagnosis as part of their differential when other common causes of obstructive lung disease have been ruled out.
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Affiliation(s)
- Kristen Flint
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chengcheng Ye
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tracey L Henry
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Pedro PI, Canário D, Lopes M, Oliveira A. Diffuse idiopathic neuroendocrine cell hyperplasia as a rare cause of chronic cough. BMJ Case Rep 2018; 11:e226203. [PMID: 30567098 PMCID: PMC6301547 DOI: 10.1136/bcr-2018-226203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A 39-year-old Caucasian woman, who has never smoked, presented a 16-year-duration chronic dry cough. She was prescribed by her general physician with corticosteroid and long-acting β-agonist inhalers assuming it was asthma, with mild symptomatic improvement. When cough got more persistent and associated with exertional dyspnoea and wheezing, a chest CT scan was performed, which showed multiple bilateral micronodular formations and diffuse mosaic lung pattern with air trapping. She was sent to our Respiratory Department and performed a bronchoalveolar lavage and cryobiopsy that were inconclusive. She underwent surgical lung biopsy with pathology revealing multiple foci of neuroendocrine cell hyperplasia and tumourlets associated with constrictive bronchiolitis, a histological pattern suggestive of diffuse idiopathic neuroendocrine cell hyperplasia (DIPNECH). DIPNECH is a rare and preinvasive disease. Presenting symptoms can be cough and breathlessness. At the time of writing, the patient is on octreotide with symptomatic improvement.
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Affiliation(s)
| | | | - Miguel Lopes
- Pulmonology, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Ana Oliveira
- Pathology, Hospital Garcia de Orta EPE, Almada, Portugal
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Yoon JY, Sigel K, Martin J, Jordan R, Beasley MB, Smith C, Kaufman A, Wisnivesky J, Kim MK. Evaluation of the Prognostic Significance of TNM Staging Guidelines in Lung Carcinoid Tumors. J Thorac Oncol 2018; 14:184-192. [PMID: 30414942 DOI: 10.1016/j.jtho.2018.10.166] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/09/2018] [Accepted: 10/18/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The TNM classification for lung cancer, originally designed for NSCLC, is applied to staging of bronchopulmonary carcinoid tumors. The validity of the eighth edition of the staging system for carcinoid tumors has not been assessed. In this study, we evaluated its prognostic accuracy by using data from a large national population-based cancer registry. METHODS Patients with typical and atypical bronchopulmonary carcinoids diagnosed between 2000 and 2013 were identified from the National Cancer Institute's Surveillance, Epidemiology and End Results registry. We used competing risks analysis to compare 10-year disease-specific survival (DSS) across stages. RESULTS Overall, 4645 patients with bronchopulmonary carcinoid tumors were identified. Worsening DSS with increasing TNM status and stage was demonstrated across both typical and atypical carcinoids, with overlaps between adjacent subcategories. The combined stages (I versus II, II versus III, and III versus IV) showed greater separation in DSS despite persistent overlaps between groups. For typical carcinoids, we found decreased DSS for stages II, III, and IV, with hazard ratios of 3.8 (95% confidence interval [CI]: 2.6-5.6), 4.3 (95% CI: 3.0-6.1), and 9.0 (95% CI: 6.1-13.1), respectively, compared with stage I. CONCLUSION The combined stage categories of the eighth edition of the TNM staging system provide useful information on outcomes for typical and atypical carcinoids. However, persistent overlaps in combined stage and subcategories of the staging system limit the usefulness of the TNM staging system, particularly in intermediate stages. These limitations suggest the need for future further study and refinement.
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Affiliation(s)
- Ji Yoon Yoon
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio.
| | - Keith Sigel
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacob Martin
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robyn Jordan
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary Beth Beasley
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cardinale Smith
- Department of Medicine, Division of Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrew Kaufman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Juan Wisnivesky
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle Kang Kim
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
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García-Fontán E, Blanco Ramos M, García JS, Carrasco R, Cañizares MÁ, González Piñeiro A. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: Report of two cases. Med Clin (Barc) 2018; 152:104-106. [PMID: 29789142 DOI: 10.1016/j.medcli.2018.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disorder characterized by a proliferation of neuroendocrine cells within the lung. It is classically described as a disease with persistent cough, dyspnea and wheezing in non-smoker middle aged females. CT of the chest reveals diffuse air trapping with mosaic pattern. PATIENTS AND METHODS We present two cases of DIPNECH that were sent to our department to perform a lung biopsy with the diagnostic suspicion of diffuse interstitial disease. Both cases were women with a history of chronic cough and moderate effort dyspnea. RESULTS AND DISCUSSION The aim of this paper is that physicians take into account this diagnostic entity before treating as an asthmatic a patient with these characteristics, not forgetting that they are prenoplastic lesions.
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Affiliation(s)
- Eva García-Fontán
- Thoracic Surgery Department, Alvaro Cunqueiro University Clinical Hospital, EOXI, Vigo, Spain
| | - Montserrat Blanco Ramos
- Thoracic Surgery Department, Alvaro Cunqueiro University Clinical Hospital, EOXI, Vigo, Spain.
| | - Jose Soro García
- Thoracic Surgery Department, Alvaro Cunqueiro University Clinical Hospital, EOXI, Vigo, Spain
| | - Rommel Carrasco
- Thoracic Surgery Department, Alvaro Cunqueiro University Clinical Hospital, EOXI, Vigo, Spain
| | - Miguel Ángel Cañizares
- Thoracic Surgery Department, Alvaro Cunqueiro University Clinical Hospital, EOXI, Vigo, Spain
| | - Ana González Piñeiro
- Pathology Department, Alvaro Cunqueiro University Clinical Hospital, EOXI, Vigo, Spain
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Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) Syndrome and Carcinoid Tumors With/Without NECH. Am J Surg Pathol 2018; 42:646-655. [PMID: 29438170 DOI: 10.1097/pas.0000000000001033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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31
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Anampa-Guzmán A, Raez LE. A Rare Case of Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia. Cureus 2018; 10:e2525. [PMID: 29942728 PMCID: PMC6015999 DOI: 10.7759/cureus.2525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/24/2018] [Indexed: 01/22/2023] Open
Abstract
We describe the case of a 53-year-old woman who visited many pneumologists without a diagnosis until finally being diagnosed with diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). It is a relatively new disease characterized by neuroendocrine cell hyperplasia in small airways. She has stable DIPNECH and neuroendocrine carcinoma with somatostatin therapy.
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Affiliation(s)
| | - Luis E Raez
- Medical Oncology and Hematology, Memorial Cancer Institute
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Persistent Lung Disease in Adults with NKX2.1 Mutation and Familial Neuroendocrine Cell Hyperplasia of Infancy. Ann Am Thorac Soc 2018; 13:1299-304. [PMID: 27187870 DOI: 10.1513/annalsats.201603-155bc] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Neuroendocrine cell hyperplasia of infancy (NEHI) is a diffuse lung disease that presents in infancy and improves during childhood. Long-term outcomes have not previously been described. In one familial cohort, we have reported that NEHI is associated with a heterozygous variant of NKX2.1/TTF1. OBJECTIVES Our objective was to determine whether pulmonary abnormalities persist in adults with NEHI, to aid in elucidating the natural history of this disease. METHODS Four adult relatives with heterozygous NKX2.1 mutation and with clinical histories compatible with NEHI enrolled in a prospective study that included questionnaires, pulmonary function tests, and chest computed tomography scans. MEASUREMENTS AND MAIN RESULTS Mild radiologic abnormalities including mosaicism were seen in all four cases. Three individuals had obstruction on pulmonary function tests, two had marked air trapping, and three had symptomatic impairments with exercise intolerance. CONCLUSIONS Although clinical improvement occurs over time, NEHI may result in lifelong pulmonary abnormalities in some cases. Further studies are required to better describe the natural history of this disease and would be facilitated by additional delineation of genetic mechanisms to enable improved case identification.
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Abstract
Asthma is one of the most common diseases of the lung. Asthma manifests with common, although often subjective and nonspecific, imaging features at radiography and high-resolution computed tomography. The primary role of imaging is not to make a diagnosis of asthma but to identify complications, such as allergic bronchopulmonary aspergillosis, or mimics of asthma, such as hypersensitivity pneumonitis. This article reviews the imaging features of asthma as well as common complications and mimics.
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Affiliation(s)
- John Caleb Richards
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Room K012f, Denver, CO 80206-2761, USA.
| | - David Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Room K012f, Denver, CO 80206-2761, USA
| | - Tilman Koelsch
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Room K012f, Denver, CO 80206-2761, USA
| | - Debra Dyer
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Room K012f, Denver, CO 80206-2761, USA
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34
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Pulmonary Neuroendocrine Cell Hyperplasia Associated with Surfactant Protein C Gene Mutation. Case Rep Pulmonol 2017; 2017:9541419. [PMID: 29250453 PMCID: PMC5700483 DOI: 10.1155/2017/9541419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/28/2017] [Accepted: 10/03/2017] [Indexed: 11/17/2022] Open
Abstract
Familial interstitial lung disease (ILD) is defined as presence of ILD in 2 or more family members. Surfactant protein C (SFTPC) gene mutations are rare, but well-known cause of familial ILD. We reported a 20-year-old male, who was referred for lung transplantation. He was symptomatic at age 3 and underwent surgical lung biopsy at age 6, which revealed a nonspecific interstitial pneumonia (NSIP) pattern. Genetic workup revealed a novel SFTPC mutation in the first intron with a C to A transversion. At age 21, he underwent bilateral lung transplantation. Explanted lung histology suggested NSIP. In addition there was pulmonary neuroendocrine cell (PNEC) hyperplasia and carcinoid tumorlets. His mother had undergone lung transplantation several years earlier, and her explanted lung showed similar pathology. SFTPC mutations are inherited in an autosomal dominant pattern. Various types of ILD have been associated with SFTPC mutation including NSIP, usual interstitial pneumonia (UIP), and desquamative interstitial pneumonia (DIP). PNEC hyperplasia has been described to occur in association with lung inflammation but has not been previously described with familial ILD associated with SFTPC mutation.
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Patel R, Collazo-Gonzalez C, Andrews A, Johnson J, Rumbak M, Smith M. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia diagnosed by tranbronchoscopic cryoprobe biopsy technique. Respirol Case Rep 2017; 5:e0275. [PMID: 29026608 PMCID: PMC5628630 DOI: 10.1002/rcr2.275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/14/2017] [Accepted: 08/21/2017] [Indexed: 11/09/2022] Open
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) remains a poorly understood clinical entity. It is currently classified as a premalignant condition by the World Health Organization (WHO). Symptoms are similar to those associated with obstructive lung disease, including breathlessness and cough. The presentation is often initially ascribed to other diseases such as asthma or chronic obstructive pulmonary disease. Here, we present what we believe is the first described case of DIPNECH diagnosed by transbronchoscopic cryoprobe biopsy. The patient presented with chronic cough, dyspnoea, pulmonary function tests consistent with obstruction, and a computed tomography (CT) scan of chest with multiple nodules. The patient went on to have transbronchoscopic cryoprobe biopsies of the lung, which confirmed the diagnosis of DIPNECH.
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Affiliation(s)
- Ravi Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine James A. Haley Veteran's Hospital Tampa FL USA.,Division of Pulmonary and Critical Care Medicine Morsani College of Medicine at the University of South Florida Tampa FL USA
| | - Carolina Collazo-Gonzalez
- Division of Pulmonary, Critical Care, and Sleep Medicine James A. Haley Veteran's Hospital Tampa FL USA.,Division of Pulmonary and Critical Care Medicine Morsani College of Medicine at the University of South Florida Tampa FL USA
| | - Arthur Andrews
- Division of Pulmonary, Critical Care, and Sleep Medicine James A. Haley Veteran's Hospital Tampa FL USA.,Division of Pulmonary and Critical Care Medicine Morsani College of Medicine at the University of South Florida Tampa FL USA
| | - Jean Johnson
- Department of Pathology James A. Haley Veteran's Hospital Tampa FL USA
| | - Mark Rumbak
- Division of Pulmonary, Critical Care, and Sleep Medicine James A. Haley Veteran's Hospital Tampa FL USA.,Division of Pulmonary and Critical Care Medicine Morsani College of Medicine at the University of South Florida Tampa FL USA
| | - Maxwell Smith
- Department of Pathology Mayo Clinic Scottsdale AZ USA
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Koliakos E, Thomopoulos T, Abbassi Z, Duc C, Christodoulou M. Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:975-979. [PMID: 28890532 PMCID: PMC5602477 DOI: 10.12659/ajcr.904468] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient: Female, 69 Final Diagnosis: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia Symptoms: Occasional and mild shortness of breath • persistent nocturnal cough Medication: — Clinical Procedure: Surgical intervention: right middle lobectomy Specialty: Surgery
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Affiliation(s)
- Evangelos Koliakos
- Department of General Surgery, Hospital of Valais (CHVR), Sion, Switzerland
| | | | - Ziad Abbassi
- Department of General Surgery, Hospital of Valais (CHVR), Sion, Switzerland
| | - Christophe Duc
- Department of Histopathology, Hospital of Valais (CHVR), Sion, Switzerland
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Tseng HJ, Henry TS, Veeraraghavan S, Mittal PK, Little BP. Pulmonary Function Tests for the Radiologist. Radiographics 2017; 37:1037-1058. [DOI: 10.1148/rg.2017160174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Hsiang-Jer Tseng
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Travis S. Henry
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Srihari Veeraraghavan
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Pardeep K. Mittal
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Brent P. Little
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
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Gorospe L, Muñoz-Molina GM, Farfán-Leal FE, Cabañero-Sánchez A, García-Gómez-Muriel I, Benito-Berlinches A. Association of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) with lung adenocarcinoma: A radiologist's perspective. Lung Cancer 2017. [PMID: 28648688 DOI: 10.1016/j.lungcan.2017.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Luis Gorospe
- Ramón y Cajal University Hospital Madrid, Spain.
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Warren WA, Dalane SS, Warren BD, Peterson PG, Boyum RD, Kelly W. Ten Years of Chronic Cough in a 64-Year-Old Man With Multiple Pulmonary Nodules. Chest 2017; 150:e81-5. [PMID: 27613994 DOI: 10.1016/j.chest.2016.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/28/2016] [Accepted: 03/28/2016] [Indexed: 11/18/2022] Open
Abstract
A 64-year-old male former smoker with a history of prostate cancer presented to our pulmonary clinic, complaining of nonproductive cough for 10 years. Prior evaluation included treatment for upper airway cough syndrome and gastroesophageal reflux, stopping angiotensin-converting enzyme inhibitor, and initiation of inhaled β-agonists. Esophageal pH monitoring indicated silent reflux, and proton pump inhibitor therapy was started. He continued to cough and complain of dyspnea. Physical examination produced unremarkable results, with no evidence of lymphadenopathy. Pulmonary function tests showed a pseudo-restrictive pattern with air trapping, hyperreactivity, and incomplete bronchodilator responsiveness: FEV1, 2.48 L (69% of predicted); FVC, 3.57 L (75% of predicted); FEV1/FVC, 92%; total lung capacity, 7.00 L (100% of predicted); and residual volume, 3.05 L (136% of predicted). Laboratory studies, including a complete metabolic panel, prostate-specific antigen test, and complete blood count, yielded normal results.
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Affiliation(s)
- Whittney A Warren
- Department of Pulmonary and Critical Care, Walter Reed National Military Medical Center, Bethesda, MD.
| | - Scott S Dalane
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Bryce D Warren
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Paul G Peterson
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Rodney D Boyum
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, MD
| | - William Kelly
- Department of Pulmonary and Critical Care, Walter Reed National Military Medical Center, Bethesda, MD
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Sauer R, Griff S, Blau A, Franke A, Mairinger T, Grah C. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia diagnosed by transbronchial lung cryobiopsy: a case report. J Med Case Rep 2017; 11:95. [PMID: 28385164 PMCID: PMC5383988 DOI: 10.1186/s13256-017-1254-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Micronodular lesions are common findings in lung imaging. As an important differential diagnosis, we describe a case of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia; it is notable that the diagnosis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia is often delayed. This case provides supporting evidence to establish lung biopsy by cryotechnique as the option of first choice when considering a diagnostic strategy for micronodular lung lesions. CASE PRESENTATION We report a case of a 65-year-old white woman who presented with obstructive symptoms of chronic coughing and dyspnea confirmed by conventional lung function tests. A computed tomography scan presented disseminated micronodules in all the lobes of her lungs. With the help of bronchoscopic cryobiopsy it was possible to obtain a high yield sample of lung parenchyma. On histologic examination, the micronodules correlated with a diffuse neuroendocrine cell hyperplasia. In the context of clinical symptoms, radiological aspects, and histomorphological aspects we made the diagnosis of a diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Obstructive symptoms were treated with inhaled steroids and beta-2-mimetics continuously. A comparison between current computed tomography scans of our patient and scans of 2014 revealed no significant changes. Last ambulatory checks occurred in January and May of 2016. The course of disease and the extent of limitation of lung function have remained stable. CONCLUSIONS The diagnosis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia is best made in a multidisciplinary review including clinical presentation, lung imaging, and histomorphological aspects. This report and current literature indicate that transbronchial lung cryobiopsy can be used as a safe and practicable tool to obtain high quality biopsies of lung parenchyma in order to diagnose micronodular lesions of the lung.
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Affiliation(s)
- R. Sauer
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Walterhöferstr. 11, Berlin, 14165 Germany
| | - S. Griff
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Walterhöferstr. 11, Berlin, 14165 Germany
| | - A. Blau
- Department of Respiratory Medicine, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - A. Franke
- Group Practice of Respiratory Medicine, Klosterstraße 34/35, Berlin, Germany
| | - T. Mairinger
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Walterhöferstr. 11, Berlin, 14165 Germany
| | - C. Grah
- Department of Respiratory Medicine, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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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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Kadara H, Scheet P, Wistuba II, Spira AE. Early Events in the Molecular Pathogenesis of Lung Cancer. Cancer Prev Res (Phila) 2016; 9:518-27. [PMID: 27006378 DOI: 10.1158/1940-6207.capr-15-0400] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/01/2016] [Indexed: 11/16/2022]
Abstract
The majority of cancer-related deaths in the United States and worldwide are attributed to lung cancer. There are more than 90 million smokers in the United States who represent a significant population at elevated risk for lung malignancy. In other epithelial tumors, it has been shown that if neoplastic lesions can be detected and treated at their intraepithelial stage, patient prognosis is significantly improved. Thus, new strategies to detect and treat lung preinvasive lesions are urgently needed in order to decrease the overwhelming public health burden of lung cancer. Limiting these advances is a poor knowledge of the earliest events that underlie lung cancer development and that would constitute markers and targets for early detection and prevention. This review summarizes the state of knowledge of human lung cancer pathogenesis and the molecular pathology of premalignant lung lesions, with a focus on the molecular premalignant field that associates with lung cancer development. Lastly, we highlight new approaches and models to study genome-wide alterations in human lung premalignancy in order to facilitate the discovery of new markers for early detection and prevention of this fatal disease. Cancer Prev Res; 9(7); 518-27. ©2016 AACR.
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Affiliation(s)
- Humam Kadara
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. The University of Texas Graduate School of Biomedical Sciences, Houston, Texas.
| | - Paul Scheet
- The University of Texas Graduate School of Biomedical Sciences, Houston, Texas. Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Avrum E Spira
- Section of Computational Biomedicine, Boston University School of Medicine, Boston University, Boston, Massachusetts
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111In-Pentetreotide Imaging in Diffuse Idiopathic Neuroendocrine Hyperplasia of the Lung. Clin Nucl Med 2016; 41:239-40. [DOI: 10.1097/rlu.0000000000001079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Trisolini R, Valentini I, Tinelli C, Ferrari M, Guiducci GM, Parri SNF, Dalpiaz G, Cancellieri A. DIPNECH: Association Between Histopathology and Clinical Presentation. Lung 2016; 194:243-7. [PMID: 26880164 DOI: 10.1007/s00408-016-9854-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/05/2016] [Indexed: 02/01/2023]
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disorder which can be an incidental finding in imaging tests performed during the investigation of another condition, or is the final diagnosis in patients evaluated for chronic obstructive complaints. To explore the possible association between specific histopathology features and the mode of clinical presentation, we retrieved the clinical, functional, radiological, and pathological data of all 13 patients diagnosed with DIPNECH at our Institution over a 14-year period (2000-2014). As compared to patients with incidental disease (6/13, 46 %), patients with symptomatic disease were younger [mean (SD): 57.7 vs. 68.7 years, p = 0.046], were more likely to have mosaic attenuation (100 vs. 0 %, p = 0.001) and small multiple nodules (100 vs. 17 %, p = 0.005) at CT, and showed a significantly higher number of foci of linear neuroendocrine proliferation [median (IQR): 28 (13-37) vs. 6 (5-13), p = 0.018] and of tumorlets [median (IQR): 10 (8-20) vs. 1 (1-1), p = 0.002] at histology. Incidental disease was found in association with pulmonary adenocarcinoma in five out of six patients (83.3 %). The results of our study provide preliminary evidence that symptomatic patients with DIPNECH represent a specific subset characterized by younger age and a higher burden of foci of neuroendocrine proliferation.
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Affiliation(s)
- Rocco Trisolini
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi, via Albertoni 15, 40138, Bologna, Italy.
- Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy.
| | | | - Carmine Tinelli
- Clinical Epidemiology & Biometry Service, IRCCS Policlinico San Matteo, Pavia, Italy
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Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a pre-invasive generalized proliferation of pulmonary neuroendocrine (PNE) cells, which has been described in combination with carcinoid tumorlets, obliterative bronchiolitis, and other fibrotic lung changes. Since its first recognition as a distinct syndrome in 1992, variable clinico-pathologic features have been used to diagnose DIPNECH in small case series and case reports. We recently proposed the use of the following criteria for the pathologic diagnosis of the syndrome on lung resection specimens: the presence of multifocal neuroendocrine cell hyperplasia, as defined by the presence of 5 or more PNE cells in at least 3 separate small airways combined with 3 or more carcinoid tumorlets. At diagnosis, 53% of DIPNECH patients present with a synchronous carcinoid tumor and 24% have obliterative bronchiolitis. To our knowledge, only 1 patient has been diagnosed with a carcinoid tumor subsequent to a DIPNECH diagnosis and the syndrome is not associated with an increased incidence of high-grade neuroendocrine neoplasms. Patients have usually a stable disease and only 26% experience clinical and/or radiographic deterioration. There is no evidence that treatment with octreotide or other medications improves the prognosis of DIPNECH patients.
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Affiliation(s)
- Alberto M Marchevsky
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Ann E Walts
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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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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