title: Diagnosis of hepatocellular carcinoma (HCC) in a high-risk patient by using transgastric EUS-guided fine-needle biopsy (EUS-FNA).
abstract: Hepatocellular carcinoma (HCC) is the most common primary malignancy arising within the liver and most often affects individuals with chronic hepatitis and/or liver cirrhosis. Patients often present at an advanced stage of disease or with poor liver function, thus limiting treatment options and resulting in a poor prognosis of the disease. Therefore, an early tissue-based diagnosis of HCC is necessary to direct further work-up and treatment. We present the case of a 70-year-old man with alcoholic cirrhosis at stage Child C, in whom a tumor nodule was found incidentally within the left lobe of the liver. Percutaneous biopsy was deemed too dangerous because a deteriorated liver function with coagulopathy was present, and a significant amount of ascites surrounded the small cirrhotic liver. To obtain a conclusive diagnosis, we performed transgastric fine-needle biopsy of the tumor under direct endosonographic guidance (EUS-FNA) without complications. Cytologic examination confirmed the presence of a well differentiated HCC. Based on this finding, super-selective CT-guided angiography and chemoembolization were subsequently performed without complications and the patient remained free of tumor relapse for the 8 months of surveillance. We conclude that EUS-guided fine-needle biopsy and cytologic examination represent a reliable alternative for tissue sampling in HCC, particularly in selected high-risk patients such as those with poor liver function and coagulation disorders; this should be assessed in prospective clinical trials.
authors.affiliation: Department of Medicine, Ruhr-University of Bochum, Germany. stephan.hollerbach@akh-celle.de
authors.forename: S
authors.initials: S
authors.lastname: Hollerbach
authors.forename: M
authors.initials: M
authors.lastname: Reiser
authors.forename: T
authors.initials: T
authors.lastname: Topalidis
authors.forename: M
authors.initials: M
authors.lastname: König
authors.forename: W
authors.initials: W
authors.lastname: Schmiegel
mesh_terms: D000368:Aged; D000792:Angiography; D001707:Biopsy, Needle / Q000295:instrumentation*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D000075202:Contraindications; D019160:Endosonography / Q000295:instrumentation*; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000098:blood supply; D008104:Liver Cirrhosis, Alcoholic / Q000473:pathology*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography