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Poster Walks: Poster Walk 7: Infection/Lung Cancer |

P229 Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) - a rare syndrome masquerading as metastatic carcinoma

S. Hameed; D. Khanapara; A. Abraham
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Montefiore Medical Center, New York, United States


Copyright 2017, American College of Chest Physicians and Swiss Respiratory Society SGP. All Rights Reserved.


Chest. 2017;151(5_S):A129. doi:10.1016/j.chest.2017.04.135
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Introduction: DIPNECH is a rare syndrome characterized by hyperplasia of pulmonary neuroendocrine cells (PNEC). It can present as an incidental finding on imaging or the cause of chronic obstructive pulmonary disease. We report a case of DIPNECH found incidentally on imaging in an asymptomatic patient.

Case: A 70 year-old woman with hepatitis C cirrhosis and hypertension was evaluated for right lower lobe opacity of the lung seen on screening imaging done for hepatocellular carcinoma. She had no pulmonary symptoms. CT chest revealed a spiculated mass-like opacity in the superior segment of the right lower lobe measuring 2.1 x 1.5 cm with multiple sub-centimeter bilateral pulmonary nodules, thought to represent metastatic disease. The right lower lobe nodule was Positron Emission Tomography(PET) avid with a standardized uptake value(SUV) of 5.9. Transbronchial biopsy was nondiagnostic. Subsequently, she underwent video assisted thorascopic surgery (VATS) with lung biopsy of the 2.1cm nodule as well as one of the sub-centimeter nodules. The pathology confirmed several carcinoid tumorlets located with peribronchial/peribronchiolar distribution and positive immunoreactivity for neuroendocrine cell, suggestive of DIPNECH. Surveillance imaging three months later showed no new nodules.

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