Clin Endosc.  2012 Jun;45(2):117-123. 10.5946/ce.2012.45.2.117.

Endoscopic Ultrasound-Guided Fine Needle Aspiration in Submucosal Lesion

• Moon JS

• KMID: 2048847
• DOI: http://doi.org/10.5946/ce.2012.45.2.117

Abstract

A submucosal lesion, more appropriately a subepithelial lesion, is hard to diagnose. Endoscopic ultrasonography is good to differentiate the nature of submucosal lesion. For definite diagnosis, tissue acquisition from submucosal lesion is necessary, and many methods have been introduced for this purpose mainly by endoscopic ultrasonography, such as endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), EUS-guided Trucut Biopsy (TCB), and EUS-guided fine needle biopsy (FNB). For EUS-FNA, adequate processing of specimen is important, and for proper diagnosis of EUS-FNA specimen, both cytologic and histologic examinations, including immunohistochemical stains, are important. All gastrointestinal stromal tumors have some degree of malignant potential, so there have been a lot of efforts and methods to increase diagnostic yields of submucosal lesion. We herein review the current hot topics on EUS-FNA for submucosal tumor, such as needles, on-site cytopathologists, immunohistochemical stains, EUS-TCB, EUS-FNB, Ki-67 labelling index, DOG1, and combining EUS-FNA and EUS-TCB.

Keyword

Endoscopic ultrasound; EUS-guided fine needle aspiration; Submucosal tumors; Gastrointestinal stromal tumors

MeSH Terms

Biopsy
Biopsy, Fine-Needle
Coloring Agents
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Endosonography
Gastrointestinal Stromal Tumors
Needles
Coloring Agents

Figure

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  Fig. 1 Endoscopic finding. An extrinsic compression and erosions of salt and pepper type were found at the anterior wall of the duodenal bulb.

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  Fig. 2 Computed tomographic finding. The enhanced computed tomography scan showed a large mass, proving heterogenous enhancement in the periphery and low attenuation, suggesting necrosis, in the central area of the lesion.

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  Fig. 3 Endoscopic ultrasonography (EUS) Findings. (A) A 78×86 mm hypoechoic mass was found, characterizing anechoic in the center of the lesion. (B) EUS-guided Trucut biopsy was performed.

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  Fig. 4 Gross findings. (A) It showed malignant gastrointestinal stromal tumor (GIST) (>10 cm), subserosal, exophytic polypoid type at the stomach body along the lesser curvature. (B) Cut section showed malignant GIST (>10 cm) with solid and cystic, hemorrhagic and necrotic, fish-flesh, sarcomatous cut surfaces.

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  Fig. 5 Microscopic findings. (A) Cellular epithelioid malignant gastrointestinal stromal tumor (GIST) with discohesive pattern of growth, nuclear anaplasia & pleomorphism (H&E stain, ×100). (B) Cellular epithelioid malignant GIST with frequent mitoses >5/50 high power fields (H&E stain, ×200). (C) Cytoplasmic membranous immunoreactivity for C-KIT (CD117) (Immunohistochemical stain, ×200). (D) Diffuse strong cytoplasmic immunoreactivity for CD34 (Immunohistochemical stain, ×40).

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