A 77-year-old hypertensive, diabetic, former-smoker male with a history of aortoiliac aneurysm repair presented with significant claudication and persistent productive cough, prompting evaluation. CT scans revealed multiple small pulmonary nodules (Figure 1A) and mosaic attenuation (Figure 1B), indicative of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH), and a concerning 3.0-cm mass (Figure 1C) in the superior segment of the lower left pulmonary lobe, with slightly irregular margins, suggestive of carcinoma considering the patient’s high-risk profile. 18F-fluorodeoxyglucose PET-CT showed exclusive radiotracer uptake in the suspected lesion, with a maximum standardized uptake value of 6.0 (Figure 1D). Lobectomy was performed, and the mass was confirmed as a mucinous adenocarcinoma (programmed death-ligand 1 = 0%), with no mutational drivers, accompanied by multiple foci of neuroendocrine hyperplasia. The radiologist’s expertise was crucial for distinguishing the imaging patterns of these lesions, highlighting the importance of radiological assessment in guiding clinical decisions.

 
Correctly differentiating DIPNECH nodules from malignancies is crucial to prevent misdiagnosis,(1) ensuring appropriate staging and management. This particular case stands out given the established female predominance in the epidemiology of DIPNECH within existing literature. (2) This underscores the necessity for radiologists to be vigilant for DIPNECH when evaluating male patients, despite the atypical gender presentation, when imaging phenotypes favor this condition, as in this case.
 
AUTHOR CONTRIBUTIONS
 
MdSBCP and AKM: image selection and preparation. AKM and FMC: gathering of clinical information. MdSBCP, AKM, and FMC: writing of the manuscript. AKM and FMC: reviewing of the final version of the manuscript. All authors approved that final version.
 
CONFLICTS OF INTEREST
 
None declared.
 
REFERENCES
 
1.           Inomata S, Matsumura Y, Kobayashi Y, Yamaguchi H, Watanabe M, Ozaki Y, et al. Lung adenocarcinoma coexisting with diffuse idiopathic pulmonary neuroendocrine cell hyperplasia manifesting as multiple pulmonary nodules: A case report. Thorac Cancer. 2022;13(21):3076-3079. https://doi.org/10.1111/1759-7714.14662
2.           Gorospe L, Muñoz-Molina GM, Farfán-Leal FE, Cabañero-Sánchez A, Gar-cía-Gómez-Muriel I, Benito-Berlinches A. Association of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) with lung adeno-carcinoma: A radiologist’s perspective. Lung Cancer. 2017;110:77-79. https://doi.org/10.1016/j.lungcan.2017.06.010