md-medicaldata

Authors

 

Bosiljka Krajnović Pavlović ^1,2, Aleksandra Lovrenski ^1,2, Tanja Lakić ^1,4, Aleksandra Ilić ^1,4, Siniša Maksimović ^1,2, Milan Popović^1,3, Dragana Tegeltija<sup>1,2

1</sup>Medicinski fakultet, Univerzitet u Novom Sadu, Republika Srbija
²Institut za plućne bolesti Vojvodine, Sremska Kamenica, Republika Srbija
³Institut za onkologiju Vojvodine, Sremska Kamenica, Republika Srbija
⁴Univerzitetski klinički centar Vojvodine, Novi Sad, Republika Srbija

 

UDK: 616.24-006.6
618.19-006.6-06

The paper was received / Rad primljen: 15.11.2023.

Accepted / Rad prihvaćen: 30.111.2023.

 

Correspondence to:

Dr Bosiljka Krajnović
Institut za plućne bolesti Vojvodine
Put doktora Goldmana 4
21208 Sremska Kamenica
Tel: 060 456 1630
e-mail: pavlovicbosiljka@yahoo.com

 

 

Sažetak

 

 

Uvod: DIPNECH (eng. diffuse idiopathic pulmonary neuroendocrine cell hyperplasia) predstavlja retko oboljenje koje može biti asimptomatsko ili se može manifestovati simptomima konstriktivnog bronhiolitisa - nedostatkom vazduha i nadražajnim kašaljem što može biti pogrešno protumačeno kao astma. Prikaz dva slučaja: Bolesnicama starosti 69 i 74 godina, sa istorijom operativno lečenog duktalnog karcinoma dojke i aktuelnim osećajem dispneje i nadražajnim kašljem, u sklopu redovnih onkoloških kontrola načinjena je kompjuterizovana tomografija pluća. Registrovane su višestruke nodularne promene koje su bile suspektne na metastaze primarnog  malignog oboljenja. Spirometrijskim pregledom verifikovan je lak opstruktivni poremećaj ventilacije. Nakon preoperativne pripreme urađena je hirurška intervencija (atipična resekcija gornjeg i srednjeg režnja desno kod prve i segmentektomija prvog segmenta levo kod druge pacijentkinje). Patohistološkom analizom nađene su linearne proliferacije uniformnih okruglastih ćelija fino dispergovanog jedarnog hromatina izgleda „so i biber“ iznad bazalne membrane bronhiolarne sluznice, morfoloških karakteristika DIPNECH-a. Pored toga nađu se područja opisanih ćelija sa invazijom bazalne membrane koje odgovaraju tumorletu (veličina <5mm) i karcinoidu (veličina >5mm) stadijuma IA. Imunohistohemijskom analizom (CD56, sinaptofizin, hromogranin: pozitivni; estrogen, progesteron, TTF-1, napsin A i GATA- 3: negativni) u oba slučaja potvrđena je neuroendokrina diferencijacija opisanih ćelija. Zaključak: DIPNECH se radiološki prezentuje kao noduli u plućnom parenhimu što klinički može pobuditi sumnju na metastasku bolest kod pacijenata sa ranije dijagnostikovanim malignim oboljenjem te se dijagnoza mora potvrditi bioptičkim uzorkom.

 

Ključne reči:

DIPNECH, karcinoid, tumorlet, neuroendokrine ćelije

 

 

 

Abstract

 

Intraduction: DIPNECH is a rare disease that may be asymptomatic or present with constrictive bronchiolitis symptoms- shortness of breath and irritating cough which can be misinterpreted as asthma. Outlines of cases: A 69-years-old and 74-years-old patients with surgically treated ductal breast cancer history and current dyspnea and irritable cough, underwent lung computed tomography as part of regular oncological follow-ups. Multiple noduli were registered that were suspicious for primary malignancy metastases. Spirometric examination verified mild obstructive ventilation disorder. After preoperative preparation, surgery was done (right upper and middle lobes atypical resection in the first and left segmentectomy of the first segment in the second patient). Pathohistological analysis revealed linear uniform round cells proliferations with finely dispersed nuclear chromatin with "salt and pepper" appearance above the bronchial mucosa basement membrane, morphological characteristics of DIPNECH. In addition, areas of the described cells with basal membrane invasion corresponding to the tumorlet (size <5mm) and carcinoid (size >5mm) stage IA were found. Immunohistochemical analysis (CD56, synaptophysin, chromogranin: positive; estrogen, progesterone, TTF-1, napsinA and GATA-3: negative) in both cases confirmed the neuroendocrine differentiation of the described cells. Conclusion: DIPNECH is a rare condition, and because of the imaging similarities it is difficult to distinguish it from metastic disease in the lung parenchyma. Therefore, as a part of routine practice, a definitive diagnosis of DIPNECH needs to be confirmed by tissue biopsy.

 

Key words:

DIPNECH, carcinoid, tumorlet, neuroendocrine cells

 

 

 

 

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PDF: 09-Krajnović B. et al. MD-Medical Data 2022;15(3) 109-113.pdf