{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:18:23Z","timestamp":1783448303836,"version":"3.55.0"},"reference-count":47,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":165,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare entity characterised by the proliferation of neuroendocrine cells in the respiratory epithelium. DIPNECH is a pre-neoplastic condition that can progress to localised or metastatic neuroendocrine tumours (NETs). The understanding of DIPNECH remains limited, and although the European Neuroendocrine Society has recommendations for its management, there are currently no established guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This study involves a case series of three patients with DIPNECH progressing to metastasis, as well as a narrative review of previous cases screened from Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL) and SCOPUS databases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 40 documented cases of DIPNECH progression to metastasis, metastatic spread was more frequently observed in the thoracic lymph nodes, with a disproportionately high incidence of atypical carcinoid features on histological examination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with DIPNECH are a heterogeneous group, and based on current data, it is difficult to confidently predict which are more likely to experience metastases. We provide recommendations for surveillance for a range of possible outcomes, including if there is DIPNECH without metastases, if there are no metastases but particularly large lesions and when metastases are present. Patients with DIPNECH-associated atypical neuroendocrine tumours, TNM stage &amp;gt; IIA, R1 resection margins and\/or involvement of the visceral pleura ought to be monitored most closely. There are currently insufficient data to make meaningful recommendations regarding treatment options to prevent metastases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1530\/eo-25-0093","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T10:14:31Z","timestamp":1778753671000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-15","source":"Crossref","is-referenced-by-count":0,"title":["Metastatic neuroendocrine lesions in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH): a narrative review and case series"],"prefix":"10.1530","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9453-0975","authenticated-orcid":true,"given":"David 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