Limits...
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia diagnosed by transbronchial lung cryobiopsy: a case report

View Article: PubMed Central - PubMed

ABSTRACT

Background: Micronodular lesions are common findings in lung imaging. As an important differential diagnosis, we describe a case of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia; it is notable that the diagnosis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia is often delayed. This case provides supporting evidence to establish lung biopsy by cryotechnique as the option of first choice when considering a diagnostic strategy for micronodular lung lesions.

Case presentation: We report a case of a 65-year-old white woman who presented with obstructive symptoms of chronic coughing and dyspnea confirmed by conventional lung function tests. A computed tomography scan presented disseminated micronodules in all the lobes of her lungs. With the help of bronchoscopic cryobiopsy it was possible to obtain a high yield sample of lung parenchyma. On histologic examination, the micronodules correlated with a diffuse neuroendocrine cell hyperplasia. In the context of clinical symptoms, radiological aspects, and histomorphological aspects we made the diagnosis of a diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Obstructive symptoms were treated with inhaled steroids and beta-2-mimetics continuously. A comparison between current computed tomography scans of our patient and scans of 2014 revealed no significant changes. Last ambulatory checks occurred in January and May of 2016. The course of disease and the extent of limitation of lung function have remained stable.

Conclusions: The diagnosis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia is best made in a multidisciplinary review including clinical presentation, lung imaging, and histomorphological aspects. This report and current literature indicate that transbronchial lung cryobiopsy can be used as a safe and practicable tool to obtain high quality biopsies of lung parenchyma in order to diagnose micronodular lesions of the lung.

No MeSH data available.


Strong positivity in immunohistochemical analysis with synaptophysin
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC5383988&req=5

Fig3: Strong positivity in immunohistochemical analysis with synaptophysin

Mentions: By method of transbronchial cryobiopsy (ERBECRYO2, diameter 1.9 mm; Tübingen, Germany), lung tissue samples of the middle and inferior lobes of her right lung were gained. The material was formalin fixed and paraffin embedded, cut into 4 μm-thick sections and stained with hematoxylin and eosin (H&E). The fragmented biopsy measured an overall area of 30.9 mm2 compared with the initial biopsy of 7.5 mm2 (Mirax Viewer Image Software Version 1.12, Zeiss Microimaging, Oberkochen, Germany and 3D Tech, Budapest, Hungary). Besides small airways, a regular lung parenchyma with an alveolar basic structure could be seen. The bronchioles were lined by a regular respiratory epithelium. Furthermore, in her bronchiolic mucosa, linear and nodular proliferates of small uniform cells with round to slightly ovoid nuclei and disperse chromatin were located within the epithelial basement membrane and bulged into the lumina (Fig. 2). Peribronchiolar and perivascular aggregates of cells showing this morphology were also found, measuring less than 5 mm in diameter at maximum. No signs of malignancy could be found; neither could we find any mitotic activity, desmoplastic stroma reaction, or any invasive aspect. In association with the described cell cluster, slight fibrosis could be seen. In the Elastica van Gieson stain, the walls of some bronchioles were broadened and contained an increased amount of elastic fibers. Immunostainings revealed strong positivity for synaptophysin (Fig. 3), chromogranin A, and CK7 in the cell cluster described. The proliferative index determined by Ki67% (Mib-1) was beneath 1% (antibodies by Roche, Rotkreuz, Switzerland). Based on these findings, the diagnosis of a neuroendocrine cell hyperplasia could be made and a possible association with DIPNECH was noted.Fig. 2


Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia diagnosed by transbronchial lung cryobiopsy: a case report
Strong positivity in immunohistochemical analysis with synaptophysin
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5383988&req=5

Fig3: Strong positivity in immunohistochemical analysis with synaptophysin
Mentions: By method of transbronchial cryobiopsy (ERBECRYO2, diameter 1.9 mm; Tübingen, Germany), lung tissue samples of the middle and inferior lobes of her right lung were gained. The material was formalin fixed and paraffin embedded, cut into 4 μm-thick sections and stained with hematoxylin and eosin (H&E). The fragmented biopsy measured an overall area of 30.9 mm2 compared with the initial biopsy of 7.5 mm2 (Mirax Viewer Image Software Version 1.12, Zeiss Microimaging, Oberkochen, Germany and 3D Tech, Budapest, Hungary). Besides small airways, a regular lung parenchyma with an alveolar basic structure could be seen. The bronchioles were lined by a regular respiratory epithelium. Furthermore, in her bronchiolic mucosa, linear and nodular proliferates of small uniform cells with round to slightly ovoid nuclei and disperse chromatin were located within the epithelial basement membrane and bulged into the lumina (Fig. 2). Peribronchiolar and perivascular aggregates of cells showing this morphology were also found, measuring less than 5 mm in diameter at maximum. No signs of malignancy could be found; neither could we find any mitotic activity, desmoplastic stroma reaction, or any invasive aspect. In association with the described cell cluster, slight fibrosis could be seen. In the Elastica van Gieson stain, the walls of some bronchioles were broadened and contained an increased amount of elastic fibers. Immunostainings revealed strong positivity for synaptophysin (Fig. 3), chromogranin A, and CK7 in the cell cluster described. The proliferative index determined by Ki67% (Mib-1) was beneath 1% (antibodies by Roche, Rotkreuz, Switzerland). Based on these findings, the diagnosis of a neuroendocrine cell hyperplasia could be made and a possible association with DIPNECH was noted.Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Micronodular lesions are common findings in lung imaging. As an important differential diagnosis, we describe a case of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia; it is notable that the diagnosis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia is often delayed. This case provides supporting evidence to establish lung biopsy by cryotechnique as the option of first choice when considering a diagnostic strategy for micronodular lung lesions.

Case presentation: We report a case of a 65-year-old white woman who presented with obstructive symptoms of chronic coughing and dyspnea confirmed by conventional lung function tests. A computed tomography scan presented disseminated micronodules in all the lobes of her lungs. With the help of bronchoscopic cryobiopsy it was possible to obtain a high yield sample of lung parenchyma. On histologic examination, the micronodules correlated with a diffuse neuroendocrine cell hyperplasia. In the context of clinical symptoms, radiological aspects, and histomorphological aspects we made the diagnosis of a diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Obstructive symptoms were treated with inhaled steroids and beta-2-mimetics continuously. A comparison between current computed tomography scans of our patient and scans of 2014 revealed no significant changes. Last ambulatory checks occurred in January and May of 2016. The course of disease and the extent of limitation of lung function have remained stable.

Conclusions: The diagnosis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia is best made in a multidisciplinary review including clinical presentation, lung imaging, and histomorphological aspects. This report and current literature indicate that transbronchial lung cryobiopsy can be used as a safe and practicable tool to obtain high quality biopsies of lung parenchyma in order to diagnose micronodular lesions of the lung.

No MeSH data available.