CHEST Guidelines-A-64-Year-Old-Woman-With-an-Incidental-Pulmonary-N

A-64-Year-Old-Woman-With-an-Incidental-Pulmonary-N

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This case study presents a 64-year-old Latin American woman referred for evaluation of an incidental pulmonary nodule found during a CT scan for abdominal pain. She had no respiratory symptoms, smoking history, or family history of lung disease. Initial diagnostics included a CT scan showing a 1.4 x 1.4 cm nodule in the right lower lobe and a mosaic lung pattern. A PET scan revealed avid uptake by the nodule. Following a surgical wedge resection, the diagnosis was identified as a typical carcinoid tumor with diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH).<br /><br />DIPNECH is a rare pulmonary condition, characterized by neuroendocrine cell hyperplasia restricted to the bronchial wall without invasion. If proliferation breaches the basement membrane and forms nodules over 5 mm, it can progress to carcinoid tumors. It occurs typically in nonsmoking women in their fifth or sixth decades. Symptomatic patients may experience persistent cough and dyspnea, often misdiagnosed as chronic obstructive pulmonary disease (COPD) or asthma. <br /><br />The patient's diagnosis was confirmed via video-assisted thoracoscopy, showing neuroendocrine cell hyperplasia and typical carcinoid tumor traits. Treatment involved surgical resection, and she remained symptom-free three months post-procedure. Continued surveillance and management may include corticosteroids, bronchodilators, and in severe cases, somatostatin analogs. Regular monitoring with CT scans is critical for assessing progression, with reported 5-year survival rates for DIPNECH at around 90%. <br /><br />This case highlights the under-recognition of DIPNECH, illustrating its potential progression pathway and the importance of comprehensive histopathological evaluation for proper diagnosis and management.

Keywords

pulmonary nodule

DIPNECH

carcinoid tumor

neuroendocrine cell hyperplasia

nonsmoking women

thoracoscopy

surgical resection

CT scan

PET scan

5-year survival rate