Diagnosis of lymphoma by endoscopic ultrasound-assisted transendoscopic direct retroperitoneal lymph node biopsy: A case report (with video)

Abstract

Since its introduction in the early 1990s, endoscopic ultrasound-assisted fine-needle aspiration (EUS-FNA) has been used for sampling of extraintestinal mass lesions and peri-intestinal lymphadenopathy. Although EUS-FNA is highly accurate, lymphomas can be challenging to diagnose using EUS-FNA. We present the case of a 60-year-old male who had experienced upper abdominal discomfort for 1 month. Computerized tomography (CT) examination revealed multiple soft-tissue shadows located above the pancreatic body. The biggest shadow had a cross-sectional area of 7.7 cm × 7.2 cm. Positron emission tomography-CT (PET-CT) imaging showed increased uptake of 18F-FDG by these soft-tissue shadows. To investigate further, EUS was performed and it revealed the presence of multiple hypoechoic round lymph nodes. During the procedure, EUS-FNA was performed, but only a few dyskaryotic cells were observed by cytological evaluation. EUS-assisted retroperitoneoscopy and lymph node biopsy were performed to obtain more tissue for immunohistochemical analysis and subclassification of lymphoma. Finally, the patient was diagnosed with non-Hodgkin lymphoma, germinal center B-cell-like diffuse large B-cell lymphoma by this technique. EUS-assisted transendoscopic retroperitoneal lymph node biopsy is an alternative procedure for the diagnosis of lymphomas.

Accuracy of endoscopic ultrasound-guided tissue acquisition in the evaluation of lymph nodes enlargement in the absence of on-site pathologist

“…This observation could be related to needle selection because the majority of the samples included in our study were acquired with biopsy needles (61.3%), although the choice of needle was not significant. A plausible explanation is the ability of biopsy needles to procure a larger amount of specimen with preserved cellular architecture, which is crucial for certain diagnoses, such as lymphoproliferative diseases and some inflammatory conditions[ 20 ]. Our findings are in agreement with previous studies that achieved adequate specimens in one to two needle passes[ 21 , 22 ].…”

Endoscopic ultrasound-guided puncture suture device versus metal clip for gastric defect closure after endoscopic full-thickness resection: A randomized, comparative, porcine study

“…Color Doppler imaging was used to avoid interposed vessels at the puncture sites. [ 13 ] These anchors were spaced regularly around the periphery of the target lesion prior to EFTR. The locations of the anchors were confirmed after all were implanted.…”

Endoscopic ultrasonography in pancreatic diseases: advances in tissue acquisition

“…While EUS-FNA cytology is suitable for evaluation of pancreatic masses, lymph nodes, and subepithelial tumors, its role is limited in investigation of disorders for which histological samples with preserved tissue architecture are necessary to reach a diagnosis, such as autoimmune pancreatitis 17 , lymphomas 18 19 , well-differentiated adenocarcinomas, and mesenchymal tumors 20 . Moreover, the yield of true histological samples and quality of the sample material for performance of ancillary testing, for example, identification of specific neoplasm-related molecular biomarkers, DNA sequencing and characterization of neoplastic features such as desmoplastic fibrosis, was shown to be suboptimal, especially when the smaller 25 G EUS-FNA needles were used 21 or when rapid onsite cytopathology evaluation was unavailable 22 23 .…”