Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) represents a useful
and less invasive procedure for procuring pathological specimens from lesions located
either in proximity to or within the gastrointestinal wall [1]
[2]. Contrast-enhanced EUS (CE-EUS) is known to be advantageous for differential diagnosis
in various types of tumors, as it provides real-time blood flow images [3]. In this report, we present a patient with a gastric submucosal tumor associated
with hemorrhage, in whom CE-EUS-guided FNA (CE-EUS-FNA) had a pivotal role in precisely
identifying the lesion and facilitating accurate FNA.
A 60-year-old man initially presented with abdominal pain. A computed tomography scan
revealed the presence of a tumor on the gastric wall, with possible perigastric hemorrhage
([Fig. 1]). Subsequently EUS-FNA was attempted on the gastric lesion, but EUS failed to detect
the tumor because of the hemorrhage surrounding the stomach ([Fig. 2]). Consequently, CE-EUS was performed, enabling the identification of a 20-mm tumor
that was contiguous with the gastric wall ([Fig. 3]). Subsequent CE-EUS-FNA using a 22-gauge fine-needle biopsy (FNB) needle was performed
successfully and precisely ([Fig. 4]; [Video 1]). No adverse events related to the procedure were recognized.
Fig. 1 Computed tomography image showing a tumor connected with the gastric wall, with possible
perigastric hemorrhage.
Fig. 2 Endoscopic ultrasound image showing that the tumor connected with the gastric wall
could not be detected because of hemorrhage around the stomach.
Fig. 3 Contrast-enhanced endoscopic ultrasound images showing the 20-mm tumor (arrows), which
was connected with the gastric wall.
Fig. 4 Contrast-enhanced endoscopic ultrasound images showing fine-needle biopsy (FNB), with
a 22-gauge FNB needle, being successfully and accurately performed for the tumor.
Contrast-enhanced endoscopic ultrasound-guided fine needle aspiration was performed
for a submucosal tumor with surrounding hemorrhage.Video 1
Pathological examination of the obtained specimens revealed tumor cells characterized
by spindle-shaped nuclei with positivity for c-kit and CD34 ([Fig. 5]). These findings were consistent with a diagnosis of gastrointestinal stromal tumor
(GIST). Given the presence of intra-abdominal hemorrhage, surgical resection was undertaken
following neoadjuvant therapy involving imatinib. The final pathological examination
confirmed the diagnosis of a GIST.
Fig. 5 Pathological appearance of the specimen showing tumor cells with spindle-shaped nuclei
on hematoxylin and eosin (H&E) staining, and positivity on immunohistochemistry with
c-kit (+) and CD34 (+), consistent with a diagnosis of gastrointestinal stromal tumor
(GIST).
Recent studies regarding CE-EUS-FNA for pancreatic lesions have not conclusively
demonstrated its superior diagnostic capabilities over B-mode-based EUS-FNA [4]
[5]. In this case, however, CE-EUS enabled us to detect the tumor precisely and subsequently
to perform precise needle puncture based on real-time perfusion imaging. CE-EUS-FNA
could be
useful in cases where lesion detection is interfered with by confounding factors such
as
hemorrhage.
Endoscopy_UCTN_Code_TTT_1AS_2AB
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website athttps://mc.manuscriptcentral.com/e-videos.
