Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is an extremely rare pulmonary disorder at the benign end of the neuroendocrine cells proliferation spectrum. It is mainly seen in non-smoker middle-age females with a history of chronic cough or asthma. On imaging, it is characterized by several nodules and extensive mosaic attenuation. It is, however, recognized with increasing frequency.

DIPNECH typically occurs in middle-to-late age, and there is an increased female predilection 3,10. Most patients tend to be non-smokers 10.

Most are asymptomatic, where discovery is made incidentally on thoracic imaging for an unrelated reason. Some, however, may present with symptoms such as an insidious cough, a slowly progressive dyspnea, or an asthma-like presentation 7,10.

It is characterized by a generalized proliferation of scattered single cells, small nodules or linear proliferations of pulmonary neuroendocrine cells (enterochromaffin cells, "Kulchitsky cells") 9. It is sometimes considered to be a precursor to pulmonary carcinoid tumors.

Various features have described, each of which is non-specific on their own. These include:

The rarity of the condition poses some clinical challenge in establishing treatment and assessing prognosis. Limited studies suggest that the condition can have a variable prognosis ranging from clinical improvement to being stable to rare clinical deterioration 5. Various treatment strategies have been described which include somatostatin analogs, azithromycin, and lung transplantation 10.

The first clinical series of six cases describing DIPNECH was published by Aguayo et al. in 1992 11.


Article information

rID: 20656
System: Oncology, Chest
Synonyms or Alternate Spellings:
  • Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)

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Cases and figures

  • Case 1
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  • Case 2: with probable carcinoid
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  • Case 3
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