DISCUSSION: Pulmonary neuroendocrine, or Kulchitsky-type cells, are rare airway epithelial cells that release bioactive compounds. Neuroendocrine hyperplasia is a premalignant finding limited to the basement membrane or airway wall and occurs spontaneously or secondary to cigarette smoke and fibrotic lung diseases. Cellular proliferation of < 5 mm beyond these boundaries is a carcinoid tumorlet. Carcinoid tumors are tumorlets > 5 mm. Coexistence of all three often occurs in DIPNECH, a rare condition defined by WHO as a carcinoid precursor absent in other neuroendocrine cancers. DPINECH is found in 5% of patients undergoing carcinoid resection. Patients are usually misclassified as difficult to control asthma or chronic obstructive pulmonary disease. Preoperative diagnosis is rare, but should be considered in females age 45-67, with cough, dyspnea and wheezing. Radiographic clues include small pulmonary nodules, ground-glass opacities, mosaic attenuation, air trapping, and bronchiectasis. Minimum pathologic criteria for surgical specimens have been proposed, but transbronchial biopsy may suffice. Octreotide, chemotherapy, steroids, and transplant have been tried for symptomatic treatment.