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A Rare Case of Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia Diagnosed with Transbronchial Lung Cryobiopsy
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A3184 - A Rare Case of Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia Diagnosed with Transbronchial Lung Cryobiopsy
Author Block: Z. G. Swank1, A. Aragaki Nakahodo2, D. Zander3, S. Benzaquen3; 1Internal Medicine, University of Cincinnati, Cincinnati, OH, United States, 2Pulmonary Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, United States, 3University of Cincinnati, Cincinnati, OH, United States.
Introduction:
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is known as a pre-invasive form of pulmonary neuroendocrine cell proliferation, initially in airway mucosa, that can expand to form tumorlets or carcinoid tumors. High resolution computed tomography (HRCT) of the chest has often led to the recognition of DIPNECH. Images are significant for air trapping, pulmonary nodules, constrictive bronchiectasis, and ground glass opacities. DIPNECH may only involve portions of lung airways. Therefore, surgical lung biopsy has often been recommended to help aid in diagnosis.
Case presentation:
A 75-years-old female with a past medical history of ulcerative colitis (previously on Remicade until June 2016) and asthma, presented in August 2016 with complaints of cough, shortness of breath, and weight loss. Patient had a HRCT of the chest that was evident for centrilobular emphysema with scattered areas of groundglass opacities, mosaic attenuation, and scattered pulmonary nodules. Patient also had pulmonary function tests that were evident for a restrictive ventilatory defect with reduced diffusing capacity. Patient underwent flexible bronchoscopy with transbronchial lung cryobiopsy (TBLC) for potential diagnosis of cryptogenic organizing pneumonia, connective-tissue related interstitial lung disease, non-specific interstitial pneumonia, or drug-induced pneumonitis. During bronchoscopy, a total of five TBLC samples were taken from multiple sites. Pathology results showed neuroendocrine cell proliferation, consistent with DIPNECH.
Conclusion:
Traditionally, radiological imaging has played an essential role in the diagnosis of DIPNECH, as noted above. Transbronchial biopsies have previously offered limited diagnostic yield for this condition. As seen in this case, TBLC may be used as a safer alternative method to diagnose DIPNECH, as opposed to surgical lung biopsy. Increase in sampling sizes may help yield greater diagnostic results using TBLC. It may be used as a different means to obtain tissue samples versus the use of more invasive techniques.
Author Block: Z. G. Swank1, A. Aragaki Nakahodo2, D. Zander3, S. Benzaquen3; 1Internal Medicine, University of Cincinnati, Cincinnati, OH, United States, 2Pulmonary Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, United States, 3University of Cincinnati, Cincinnati, OH, United States.
Introduction:
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is known as a pre-invasive form of pulmonary neuroendocrine cell proliferation, initially in airway mucosa, that can expand to form tumorlets or carcinoid tumors. High resolution computed tomography (HRCT) of the chest has often led to the recognition of DIPNECH. Images are significant for air trapping, pulmonary nodules, constrictive bronchiectasis, and ground glass opacities. DIPNECH may only involve portions of lung airways. Therefore, surgical lung biopsy has often been recommended to help aid in diagnosis.
Case presentation:
A 75-years-old female with a past medical history of ulcerative colitis (previously on Remicade until June 2016) and asthma, presented in August 2016 with complaints of cough, shortness of breath, and weight loss. Patient had a HRCT of the chest that was evident for centrilobular emphysema with scattered areas of groundglass opacities, mosaic attenuation, and scattered pulmonary nodules. Patient also had pulmonary function tests that were evident for a restrictive ventilatory defect with reduced diffusing capacity. Patient underwent flexible bronchoscopy with transbronchial lung cryobiopsy (TBLC) for potential diagnosis of cryptogenic organizing pneumonia, connective-tissue related interstitial lung disease, non-specific interstitial pneumonia, or drug-induced pneumonitis. During bronchoscopy, a total of five TBLC samples were taken from multiple sites. Pathology results showed neuroendocrine cell proliferation, consistent with DIPNECH.
Conclusion:
Traditionally, radiological imaging has played an essential role in the diagnosis of DIPNECH, as noted above. Transbronchial biopsies have previously offered limited diagnostic yield for this condition. As seen in this case, TBLC may be used as a safer alternative method to diagnose DIPNECH, as opposed to surgical lung biopsy. Increase in sampling sizes may help yield greater diagnostic results using TBLC. It may be used as a different means to obtain tissue samples versus the use of more invasive techniques.
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