EUS tissue acquisition (EUS-TA) is rapidly shifting from fine-needle aspiration (FNA) to fine-needle biopsy (FNB), mostly because of the greater ability by the large majority of pathologists to evaluate histological samples, the easier performance of ancillary tests, and the comparable diagnostic accuracy in contrast with cytology.[1]
Periesophageal lung lesions are usually difficult to be sampled transbronchially or under computed tomography (CT) guidance, but can be easily accessed and sampled with EUS that has been traditionally done by FNA.[2] Only recently, two successful cases of transesophageal EUS-FNB of lung masses have been reported.[3]
We present, herein, a 72-year-old male with a previous history of gliosarcoma in the left frontal lobe, which was resected, followed by stereotactic radiation and adjuvant therapy with temozolomide, who presented 1 year after complaining of worsening dyspnea. Chest CT showed a large paramediastinal pulmonary mass, completely occupying the superior portion of the right hemithorax, associated with multiple enlarged mediastinal lymph nodes (larger in subcarinal space 15 mm).
A EUS was performed and showed a large necrotic area in the right mediastinum with multiple lymph nodes [Figure 1]. EUS-FNB using a 22G Fork-tip needle (SharkCore™, Medtronic, Dublin, Irland) was performed at both the mass and subcarinal lymph node sites. The histological examination showed the lymph node to be reactive in nature, while lung biopsy revealed a poorly differentiated neoplasm, solid in structure with necrosis [Figure 2] composed of severely atypical cells with spindle cell morphology and frequent mitoses [Figure 2, arrowheads], and negative for AE1/AE3, TTF1, GFAP, PAX 8, S100, and OLIG2. These findings were consistent with a thoracic recurrence of the cerebral gliosarcoma. Among diffuse high-grade gliomas, which may rarely metastasize outside the central nervous system, gliosarcomas may show a propensity for such behavior most commonly with distant metastases to lung, liver, and lymph nodes.[4,5]
Figure 1.
Ecographic view of the inferior part of the lung mass with the fine-needle biopsy needle inside
Figure 2.
Lung biopsy showing a poorly differentiated neoplasm, solid in structure with necrosis (a), composed of severely atypical cells with spindle cell morphology and frequent mitoses ([b] arrowheads)
This case clearly showed the feasibility and significance of EUS-FNB for transesophageal sampling of lung masses, especially when an unusual diagnosis is suspected.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
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Conflicts of interest
There are no conflicts of interest.
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