Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia diagnosed by transbronchial lung cryobiopsy: a case report

Abstract

BackgroundMicronodular 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 presentationWe 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.ConclusionsThe 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.

DIPNECH: pragmatic approach, uncertainties, notable associations, and a proposal for an improved definition

“…Because NECH is patchy, fulfilling stringent histopathologic criteria requires tissue specimens larger than those obtained via transbronchial or transthoracic needle biopsies (Carr et al 2015. Larger specimens can be obtained using transbronchial cryobiopsy, a technique that showed encouraging results in diagnosing bronchiolitis (Sirol Aflah Syazatul et al 2020), but only anecdotal success in DIPNECH (Sauer et al 2017, Sirol Aflah Syazatul et al 2020. Until more data concerning its yield and safety in DIPNECH accumulates, transbronchial cryobiopsy cannot be routinely recommended, and SLB remains the gold-standard diagnostic procedure.…”