背景:微结节病变是肺部影像学的常见表现。作为一种重要的鉴别诊断,我们描述了一个弥漫性特发性肺神经内分泌细胞增生的病例;值得注意的是,弥漫性特发性肺神经内分泌细胞增生的诊断经常延迟。在考虑微结节性肺病变的诊断策略时,此病例提供了通过冷冻技术建立肺活检作为首选的支持证据。
方法:我们报告一例65岁的白人妇女,经常规肺功能检查证实,其表现为慢性咳嗽和呼吸困难的阻塞性症状。计算机断层扫描显示,她的肺部所有肺叶都散布着微结节。在支气管镜冷冻活检的帮助下,有可能获得高产量的肺实质样品。在组织学检查中,微结节与弥漫性神经内分泌细胞增生有关。在临床症状的背景下,放射学方面,和组织形态学方面,我们诊断为弥漫性特发性肺神经内分泌细胞增生。阻塞性症状持续用吸入类固醇和β-2模拟物治疗。我们患者的当前计算机断层扫描扫描与2014年的扫描之间的比较显示没有显着变化。最后一次门诊检查发生在2016年1月和5月。病程和肺功能受限程度保持稳定。
结论:弥漫性特发性肺神经内分泌细胞增生的诊断最好在包括临床表现在内的多学科审查中做出。肺成像,和组织形态方面。该报告和当前文献表明,经支气管肺冷冻活检可用作安全可行的工具,以获得高质量的肺实质活检,从而诊断肺微结节病变。
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.
METHODS: 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.