Abstract Introduction DIPNECH is an uncommon idiopathic pulmonary disorder characterized by a widespread growth of neuroendocrine cells, which is either confined to respiratory mucosa or may invade locally and give rise to carcinoid tumors. Histologic characteristics include a widespread intramucosal proliferation of pulmonary neuroendocrine cells in monolayers or small colonies capable of infiltrating the bronchial basement membrane to create tumorlets. It is considered a pre-invasive lesion. We are reporting a case that offers corroborative data for robotic navigation bronchoscopic guided cryotechnique as the preferred initial approach prior to employing surgical biopsy methods. Case Description A 57-year-old female with a past medical history of asthma, lung nodules, and obstructive sleep apnea presented with difficulty breathing. She had chest imaging done, which revealed multiple solid noncalcified bilateral nodules. The largest one measured 9 mm, and a couple of the nodules showed minimal growth over a course of a few years. Robotic navigational bronchoscopy with transbronchial cryobiopsies of a couple of pulmonary nodules was performed. The fine needle aspiration specimens showed clusters of atypical, elongated nuclei with stippled chromatin exhibiting nuclear overlap consistent with neuroendocrine neoplasms. The cryobiopsy specimens revealed neuroendocrine tumors, and the current patient with a long history of multiple subcentimeter pulmonary nodules was consistent with DIPNECH. Subsequently, she was seen by the oncologist; due to low tumor burden without any significant symptomology, she is being monitored with surveillance scans without any systemic therapy. Discussion We are focusing on the role of navigational bronchoscopy-guided transbronchial cryobiopsy to establish a diagnosis of DIPNECH. Our case report and the current literature suggest that transbronchial lung cryobiopsy serves as an efficient and secure technique for collecting biopsies to establish diagnosis. Transbronchial cryobiopsy has an especially high diagnostic yield for illnesses that affect lung parenchyma in a widespread way. Recent literature distinguishes “DIPNECH syndrome” as a specific subset characterized by respiratory symptoms, obstructive physiology, and bronchiolar remodeling (constrictive/obliterative bronchiolitis). While surgical lung biopsy continues to be the preferred diagnostic method, transbronchial lung cryobiopsy, when performed in the appropriate clinical and imaging context, can often provide a less invasive diagnosis. This abstract is funded by: None
Mushtaq et al. (Fri,) studied this question.