DIPNECH: when to suggest this diagnosis on CT

Chassagnon, Guillaume; Favelle, O.; Marchand-Adam, S.; Muret, A. De; Revel, Marie‐Pierre

doi:10.1016/j.crad.2014.10.012

Cited by 55 publications

(48 citation statements)

References 34 publications

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“…For these reasons, metastatic insular thyroid carcinoma also may easily be confused with the newly described entity DIP-NECH, which has clinical features similar to metastatic disease. 19,20 Our case also demonstrated that poorly differentiated thyroid carcinoma can arise in long-standing multinodular goiters 21 and present with distant metastases. One should be cautioned that CD56 is not specific for neuroendocrine tumor and it is also expressed in several epithelial tumors, including thyroid carcinomas.…”

Section: Section Editorsupporting

confidence: 57%

Metastatic insular thyroid carcinoma masquerades as neuroendocrine tumor in lung on CT‐guided fine needle aspiration biopsy

Tong

Broadway

Chang

et al. 2016

Diagnostic Cytopathology

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Section: Section Editorsupporting

confidence: 57%

Metastatic insular thyroid carcinoma masquerades as neuroendocrine tumor in lung on CT‐guided fine needle aspiration biopsy

Tong

Broadway

Chang

et al. 2016

Diagnostic Cytopathology

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“…Neuroendocrine cell proliferations in DIPNECH are also believed to be more florid than in reactive NECH, so applying the diagnostic criteria for DIPNECH may actually be too restrictive in identifying neuroendocrine cell proliferations in response to lung injury. 34,35 Conflicts of interest and sources of funding: The authors state that there are no conflicts of interest to disclose.…”

Section: Discussionmentioning

confidence: 99%

Neuroendocrine cell proliferations in lungs explanted for fibrotic interstitial lung disease and emphysema

2018

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Using recently proposed pathological criteria, we determined the incidence of neuroendocrine cell proliferation in a series of explants with lung disease. Cases were defined as NECH (3 bronchioles with 5 endocrine cells), borderline diffuse neuroendocrine cell hyperplasia (DPNECH) (1-3 tumourlets with or without NECH), and DPNECH (3 tumourlets with NECH). Endocrine cells were identified by immunohistochemical staining for synaptophysin. There were 65 explants with interstitial lung disease (57 with non-sarcoid fibrotic lung disease, 8 with sarcoidosis), and 21 with centrilobular emphysema. Over one-third of all explant cases demonstrated histological criteria for NECH. There were three cases of DPNECH in the non-sarcoid fibrotic lung disease group (5%) and 20 cases of NECH (35%). The emphysema group had one case of DPNECH (5%), two cases of borderline DPNECH (10%), and seven cases with NECH (33%). The sarcoidosis group had two cases of DPNECH (25%) and three cases of NECH (38%). NECH is common in interstitial lung disease and emphysema. These results suggest that fibrotic lung disease is a predisposing factor for neuroendocrine cell proliferation, in addition to the known risk of epithelial neoplasms.

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“…To consider different courses of disease the term “DIPNECH syndrome” has been proposed [9]. In CT imaging DIPNECH can present not only with multiple small nodules in both lungs but also with bronchial wall thickening and mosaic perfusion [10]. Rare radiological findings include fibrotic changes comparable to a restrictive pattern in usual interstitial pneumonia [11].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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DIPNECH: when to suggest this diagnosis on CT

Cited by 55 publications

References 34 publications

Metastatic insular thyroid carcinoma masquerades as neuroendocrine tumor in lung on CT‐guided fine needle aspiration biopsy

Metastatic insular thyroid carcinoma masquerades as neuroendocrine tumor in lung on CT‐guided fine needle aspiration biopsy

Neuroendocrine cell proliferations in lungs explanted for fibrotic interstitial lung disease and emphysema

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

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