Clin Endosc.  2013 Jan;46(1):77-80. 10.5946/ce.2013.46.1.77.

Intra-Abdominal Tuberculous Lymphadenitis Diagnosed Using an Endoscopic Ultrasonography-Guided ProCore Needle Biopsy

• Lee TH
• Cho JY
• Bok GH
• Cho WY
• Jin SY

• KMID: 1792644
• DOI: http://doi.org/10.5946/ce.2013.46.1.77

Abstract

Intra-abdominal tuberculous lymphadenitis can mimic a variety of other abdominal disorders such as pancreatic cancer, metastatic lymph nodes, or lymphoma, which can make a proper diagnosis difficult. A correct diagnosis of intra-abdominal tuberculous lymphadenitis can lead to appropriate management. Endoscopic ultrasonography (EUS)-guided needle biopsy may be the procedure of choice for tissue acquisition when onsite cytopathology examination is unavailable because it is essential to obtain sufficient material suitable for the examination using an ancillary method, such as flow cytometry, molecular diagnosis, cytogenetics, or microbiological culture. We report a case of intra-abdominal tuberculous lymphadenitis diagnosed using an EUS-guided, 22-gauge histology new needle biopsy without an onsite cytopathology examination.

Keyword

Endosonography; Fine needle biopsy; Tuberculosis

MeSH Terms

Biopsy, Fine-Needle
Biopsy, Needle
Cytogenetics
Endosonography
Flow Cytometry
Hydrazines
Lymph Nodes
Lymphoma
Needles
Pancreatic Neoplasms
Tuberculosis
Tuberculosis, Lymph Node
Hydrazines

Figure

• 

  Fig. 1 Clinical findings. (A) Chest X-ray showing multiple variably sized calcified nodules in both upper lobes. (B) Upper endoscopy showing a 3×3 cm intraluminal protruding mass with normal overlying mucosa in the cardiac region of the lesser curvature of the stomach. (C) Abdominal computed tomography showing enlarged lymph nodes with rim enhancement and central low attenuation at the gastrohepatic ligament. (D) Endoscopic ultrasonography showing an enlarged heterogeneous hypoechoic lymph node.

• 

  Fig. 2 Pathological findings. (A) Tissue materials obtained using the endoscopic ultrasonography-guided ProCore biopsy. (B) Caseous necrotic material with no epithelioid granuloma (H&E stain, ×100). (C) Acid-fast bacillus (arrow) (Ziehl-Neelsen stain, ×1,000).

• 

  Fig. 3 Detailed image of the 22-gauge ProCore needle.

Reference

1. Claro I, Leitão CN, Oliveira P, et al. Tuberculous mesenteric lymphadenitis mimicking pancreatic carcinoma. Hepatogastroenterology. 1996; 43:1653–1655. PMID: 8975983.

2. Yoneda S, Yoshiji H, Kuriyama S, et al. Stage I mantle-cell lymphoma that was difficult to differentiate from abdominal tuberculous lymphadenitis and metastatic pancreatic cancer. J Gastroenterol. 2002; 37:859–862. PMID: 12424572.

3. Pombo F, Díaz Candamio MJ, Rodriguez E, Pombo S. Pancreatic tuberculosis: CT findings. Abdom Imaging. 1998; 23:394–397. PMID: 9663275.

4. Song TJ, Lee SS, Park do H, et al. Yield of EUS-guided FNA on the diagnosis of pancreatic/peripancreatic tuberculosis. Gastrointest Endosc. 2009; 69(3 Pt 1):484–491. PMID: 19231490.

5. Berger LP, Scheffer RC, Weusten BL, et al. The additional value of EUS-guided Tru-cut biopsy to EUS-guided FNA in patients with mediastinal lesions. Gastrointest Endosc. 2009; 69:1045–1051. PMID: 19249038.

6. Saftoiu A, Vilmann P, Guldhammer Skov B, Georgescu CV. Endoscopic ultrasound (EUS)-guided Trucut biopsy adds significant information to EUS-guided fine-needle aspiration in selected patients: a prospective study. Scand J Gastroenterol. 2007; 42:117–125. PMID: 17190771.

7. Iglesias-Garcia J, Poley JW, Larghi A, et al. Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc. 2011; 73:1189–1196. PMID: 21420083.

8. Lee JH, Choi KD, Kim MY, et al. Clinical impact of EUS-guided Trucut biopsy results on decision making for patients with gastric subepithelial tumors ≥ 2 cm in diameter. Gastrointest Endosc. 2011; 74:1010–1018. PMID: 21889136.