A 68-year-old woman with a diagnosis of asthma and multiple fleeting pulmonary nodules- a case report
| Autor: | Maximo E. Lama, Fortune O. Alabi, Naim K. Fanaian, Christopher O. Alabi, Hadaya A. Alkhateeb, Ashkan Ghaneie |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Carcinoid tumors Context (language use) Case Report Lung biopsy DIPNECH syndrome Adenocarcinoma 03 medical and health sciences 0302 clinical medicine Mosaic attenuation medicine SSA Asthma lcsh:RC705-779 Lung business.industry Interstitial lung disease Cancer Neuroendocrine cell hyperplasia lcsh:Diseases of the respiratory system medicine.disease SSR medicine.anatomical_structure 030228 respiratory system 030220 oncology & carcinogenesis mTOR Radiology business |
| Zdroj: | Respiratory Medicine Case Reports Respiratory Medicine Case Reports, Vol 31, Iss, Pp 101250-(2020) |
| ISSN: | 2213-0071 |
| Popis: | Diffuse idiopathic pulmonary neuroendocrine cell (DIPNECH syndrome) remains unfamiliar to most clinicians even though it was first described almost 30 years ago. Diagnosis is usually confirmed histopathologically after lung biopsy, but often, a diagnosis or suspected diagnosis can be made radiographically. In this paper, we present a case report of a 68-year-old female with shortness of breath and fleeting pulmonary nodules observed on chest CT scan. She was initially misdiagnosed with asthma based on an abnormal pulmonary function test which revealed an obstructive ventilatory defect. The classic radiographic findings of DIPNECH syndrome and the typical patient demographics that should arouse suspicion of a DIPNECH diagnosis were also illustrated. DIPNECH syndrome is a clinicopathological syndrome whereas focal NECH is a pathological diagnosis that is often made incidentally on histological examination and is encountered in a variety of settings, including in resected carcinoid tumors, in the context of reactive changes concomitant with infection, in metastatic cancer, radiation pneumonitis, intra-lobar sequestration, smokers, interstitial lung disease, and lung adenocarcinoma. There are no proven treatments for DIPNECH syndrome. In patients with obstructive ventilatory symptoms, bronchodilators with inhaled steroids are usually prescribed. Some severe cases may require parenteral steroids. Somatostatin analogs (SSA) have also been used in some cases with mixed results. Rapamycin has been used in several cases based on the purported activation of the mammalian target of rapamycin (mTOR) in DIPNECH. Some patients with large carcinoid tumors may benefit from resection. Highlights • DIPNECH syndrome is a clinicopathological diagnosis and should not be confused with incidental findings of reactive NECH after surgical lung biopsy. • DIPNECH syndrome should be suspected in any non-smoking females that present with symptoms of obstructive lung disease and mosaic attenuation on the expiratory film of HRCT of the chest. • DIPNECH syndrome has a favorable natural course with good prognosis in most patients. • Most patients with symptoms of dyspnea and cough will respond to bronchodilators and ICS. Occasionally, parenteral steroids might be needed in those with severe symptoms. • Octreotide scans can be used to identify patients that might benefit from SSA. Sirolimus has also been tried in a few cases with an excellent response. |
| Databáze: | OpenAIRE |
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