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Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
71 year old female. quite smiking 30+ years ago. Multiple lung nodules between 5-14 mm in diameter. No spiculation or cavitation. Unchanged for 6 years. No calcification, not hot on Pet.
Anyone seen this? I haven’t until today. -
15 Replies
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Only in a big academic center.
You would want to look for mosaic attenuation and even better would be air-trapping on the expiratory phase if you have it. Consider carcinoid if there are large dominant nodules.
RB-ILD would be a consideration in a former smoker if the nodules are upper lobe predominant.-
Quote from RadiologyTutor
Only in a big academic center.
You would want to look for mosaic attenuation and even better would be air-trapping on the expiratory phase if you have it. Consider carcinoid if there are large dominant nodules.
RB-ILD would be a consideration in a former smoker if the nodules are upper lobe predominant.
Didn’t see either but we didn’t do expiratory phase. Most carcinoids I have seen have been solitary. Nodules seemed too big for RB-ILD. I usually see ground glass centilobular nodules with RB-ILD.
Thanks for the feedback.-
If I was an academic chest radiologist
and discovered a new interstitial pneumonitis
I’d find the words to make the abbreviation DIP-SHET -
Quote from drad123
Didn’t see either but we didn’t do expiratory phase. Most carcinoids I have seen have been solitary.
If you are sure there is no mosaic attenuation, it is unlikely to be DIPNECH. Carcinoid is related to DIPNECH when there are larger dominant nodules since they are both neuroendocrine.
You could get a HRCT (with expiratory phase) if not sure about the mosaicism.-
In most DIPNECH cases, upon examination of the lung tissue, the overgrowth of pulmonary neuroendocrine cells is seen along the small airways, with extension through the basement membrane of the bronchiolar epithelium leading to formation of carcinoid tumorlets. When the tumorlets become greater than 5mm in size they are considered bronchial carcinoids. Upon microscopic examination, the PNE cells have round, oval, or spindle nuclei with salt-and-pepper chromatin and clear or eosinophilic cytoplasm. -Travis, WD (2004). [i]World Health Organization Classification of Tumors. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart[/i]. Lyon, France: IARC Press.
I guess the nodules are carcinoids from the pathologist’s perspective.-
Is this related to Diffuse Idiopathic Pulmonary Somatic Hyperplastic Immune Therapy?
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Nice article in most recent AJR about DIPNECH. Probably underdiagnosed, like most things chest ct related.
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Quote from RadJedi
Is this related to Diffuse Idiopathic Pulmonary Somatic Hyperplastic Immune Therapy?
I googled this. Nothing came up.
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It was a joke, look at the acronym it spells
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Guess I’m the DIP-SHET
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This is an AM thread I can get behind, on all levels. Which makes it a real zebra.
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Like a lot of “new things” e.g. CPFE, its actually not uncommon. As a FT chest radiologist, I see several biopsy-proven cases a year and many more presumptive cases (with typical features). Watch out for it!
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Why did nodules with six year stability get biopsied in the first place, or is this an existing diagnosis you just encountered?
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Quote from Valerian
Why did nodules with six year stability get biopsied in the first place, or is this an existing diagnosis you just encountered?
Existing diagnosis, previous biopsy. I was thinking metastasis until I saw the long term stability, then possible nodular pulmonary sarcoid or rheumatoid lung nodules. Then I looked up the medical record.
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Quote from turfwar
Like a lot of “new things” e.g. CPFE, its actually not uncommon. As a FT chest radiologist, I see several biopsy-proven cases a year and many more presumptive cases (with typical features). Watch out for it!
I do see findings like this. Didn’t know it was a distinct entity.
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