CTICasesDiffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) with Carcinoid Tumorlets
Imaging findings
CT in a middle-aged woman with a history of carcinoid demonstrates multiple bilateral well-defined pulmonary nodules distributed in a peri-bronchovascular pattern along with mosaic attenuation on inspiratory images consistent with air trapping from constrictive bronchiolitis. Surgical wedge resection confirmed multiple typical carcinoid tumors and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH).
Key takeaways
DIPNECH is a rare neuroendocrine proliferation of the bronchial epithelium that serves as the precursor lesion to pulmonary carcinoid tumors. CT demonstrates multiple bilateral well-defined pulmonary nodules (carcinoid tumorlets) in a peri-bronchovascular distribution, often accompanied by mosaic attenuation from bronchiolar obstruction. Definitive diagnosis requires surgical biopsy, and carcinoid nodules coexist with the DIPNECH proliferation in the surrounding lung. Somatostatin analogs may benefit patients with symptoms.
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