Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia and Granulomatous Inflammation Mimicking High-Grade Malignancy on FDG-PET/CT

Hsu, Joyce; Jia, Leo; Pucar, Darko; Williams, Hadyn T.; Keshavamurthy, Jayanth

doi:10.1097/rlu.0000000000001438

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…[ 12 19 ] Focal inflammatory and infectious conditions may further complicate a diagnosis of cocaine-induced FAH. [ 20 21 22 23 24 25 26 ] Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia similarly presents with necrotizing granulomatous inflammation, mimicking aggressive malignancy on FDG PET. [ 20 ] Tuberculosis (TB) is a chronic granulomatous infection caused by Mycobacterium tuberculosis .…”

Section: Discussionmentioning

confidence: 99%

“…[ 20 21 22 23 24 25 26 ] Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia similarly presents with necrotizing granulomatous inflammation, mimicking aggressive malignancy on FDG PET. [ 20 ] Tuberculosis (TB) is a chronic granulomatous infection caused by Mycobacterium tuberculosis . Similar to FAH, active TB presents with central necrosis and elevated FDG uptake on PET-CT, attributable to high macrophage count.…”

Section: Discussionmentioning

confidence: 99%

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Cocaine-induced pulmonary complications

et al. 2021

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Pulmonary complications of cocaine among users are common. Manifestations include lung congestion, intra-alveolar edema, and diffuse alveolar hemorrhage (DAH). Direct cellular toxicity, eosinophilia, barotrauma, and vasoactive effects of cocaine are believed to induce DAH. We present a rare case of cocaine-associated focal alveolar hemorrhage mimicking malignancy on imaging. Initially contemplated biopsy was avoided based on rapid growth of concerning lung lesion, with subsequent near resolution on follow-up. This case illustrates the importance of epidemiologic and temporal multimodality correlation when evaluating indeterminate lung lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cocaine-induced pulmonary complications

et al. 2021

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“…Pulmonary neuroendocrine cell hyperplasia was described early in the previous century (56), however the significance and role of the pathologic changes were not precisely determined. It was thought that they were secondary to other lung diseases such as interstitial lung disease, bronchiectasis, cystic fibrosis, smoking exposure, or in people who live at high altitude.…”

Section: Discussionmentioning

confidence: 99%

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia in a patient with multiple pulmonary nodules: case report and literature review

Yamin¹,

Hawarri²,

Labib³

et al. 2017

Southwest J Pulm Crit Care

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Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary disease, where carcinoid tumorlets invade the pulmonary parenchyma and bronchioles. These nests of cells release a variety of mediators including bombesin and gastrin releasing peptide that cause heterogeneous bronchoconstriction, creating a mosaic appearance on chest imaging studies, especially on expiratory scans. Clinically patients usually have long standing symptoms of shortness of breath (SOB) and cough that are difficult to distinguish from asthma. In this article we describe a case of DIPNECH in a patient with several years' history of SOB and cough, and review 179 cases of DIPNECH reported in the literature since 1992. Case PresentationA 72-year-old, non-smoking lady was admitted to the hospital in preparation for bilateral mastectomy. She recently received a diagnosis of bilateral breast invasive ductal carcinoma grade 2, estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 (HER-2) positive in the left tumor but negative in the right tumor.Her past medical history was significant for hypertension, long standing cough and dyspnea on exertion labeled as asthma poorly responsive to nebulizers. Socially, she was a house wife with no history of occupational exposure.The patient was found to be tachypneic (respiratory rate 22 breaths/minute) and hypoxemic (oxygen saturation 86% on room air). Heart rate and blood pressure were within normal limits. She had bilateral decreased breath sounds and diffuse expiratory wheezes.Chest CT scan revealed diffuse mosaic pattern and multiple pulmonary nodules in both lungs suggestive of metastases (Figure 1).

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“…Most radiologists usually only judge based on the characteristics of nodules including diameter, volume, margin, attenuation and location (32), while the oncologist who performs the CT-guided fine-needle aspiration or the respiratory specialist who performs the bronchoscopy have much more clinical experience to consider the pathology of the radiological image. Benign lesions, appear as small lung nodules and also have a malignant appearance on CT images, such as granulomatous inflammation, with a high SUV on PET-CT, include tuberculosis and pulmonary fungal infection occupying a large portion (33)(34)(35). In this case, respiratory specialists have more experience in verifying and treating them.…”

Section: Our Studymentioning

confidence: 99%

The multidisciplinary team plays an important role in the prediction of small solitary pulmonary nodules: a propensity-score-matching study

Liu¹,

Zhao²,

Wu³

et al. 2019

Ann Transl Med

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Background: According to guidelines, it is recommended that pulmonary nodules be discussed by a multidisciplinary team (MDT); however, the evidence for the effectiveness of MDT is sparse. To demonstrate the importance of the involvement of an MDT for the prediction of small solitary pulmonary nodules, we conducted this retrospective study. Methods:The patient database of those who attended our MDT and the electronic medical record system of our hospital was used; we collected all the data from patients found with small solitary pulmonary nodules (≤2 cm), which were suspected as malignant and who received a resection of the nodules. We summarized their characteristics and analyzed them, and then compared the post-operation pathological diagnosis of the patients who attended an MDT to those who did not participate in an MDT during the same period (2017-2019.2). We also collected the follow-up data. Propensity-score-matching was utilized during the process of analysis to get a more reliable conclusion.Results: Most of the qualified patients were female. Most of the small solitary pulmonary nodules (≤2 cm) were adenocarcinoma and located on the right upper lobe. There were no differences in the SUV value between malignant nodules and benign nodules. After propensity-score matching, the total positive prediction value of small solitary pulmonary nodules (≤2 cm) without an MDT was 69.4%, while that with MDT was 77.6%; the difference was not significant with a P value of 0.30. The negative predictive value of MDT was 76.2%. Conclusions:In developing countries, small solitary pulmonary nodules tend to be more correctly diagnosed with MDT.

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Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia and Granulomatous Inflammation Mimicking High-Grade Malignancy on FDG-PET/CT

Cited by 3 publications

References 8 publications

Cocaine-induced pulmonary complications

Cocaine-induced pulmonary complications

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia in a patient with multiple pulmonary nodules: case report and literature review

The multidisciplinary team plays an important role in the prediction of small solitary pulmonary nodules: a propensity-score-matching study

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