title: Diagnosis of nasopharyngeal carcinoma metastatic to mediastinal lymph nodes by endoscopic ultrasonography-guided fine-needle aspiration biopsy.
abstract: We report the case of a patient with nasopharyngeal carcinoma who was diagnosed as having metastasis in mediastinal lymph nodes and successfully underwent systemic chemotherapy without surgery. A 61-year-old male with a history of nasopharyngeal carcinoma presented with odynophagia. Examination revealed two palpable lymph nodes in the right neck. Pharyngoscopy showed a mass in the left inferior pharyngeal mucosa, and upper gastrointestinal endoscopy showed only chronic gastritis, with no sign of esophageal disease. Chest CT confirmed the presence of a non-enhancing 20-mm soft tissue mass in the paraesophageal area, with increased attenuation compared with the adjacent esophagus. To evaluate this lesion we applied endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNA). Two passes were made with a 21-gauge fine needle and the patient tolerated the procedure well, without complications. Cytological findings were compatible with metastatic squamous cell carcinoma from a nasopharyngeal tumor, and the clinical stage was determined as T3N2bM1 (stage IVC) because of mediastinal lymph node metastasis. We thus determined the nodal status of a head and neck tumor by means of EUS-FNA. In conclusion, EUS-FNA is a safe and reliable technique for evaluation of mediastinal lymphadenopathy, and is especially valuable for head and neck tumors with suspected metastasis.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tokyo, Tokyo, Japan. makoto-ishi@umin.ac.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Ishikawa
authors.forename: Joji
authors.initials: J
authors.lastname: Kitayama
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kaizaki
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sako
authors.forename: Kazunari
authors.initials: K
authors.lastname: Nakao
authors.forename: Masashi
authors.initials: M
authors.lastname: Sugawara
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Nagawa
mesh_terms: D001707:Biopsy, Needle / Q000379:methods; D002277:Carcinoma / Q000175:diagnosis / Q000556:secondary*; D003581:Cytodiagnosis; D019160:Endosonography; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology*; D018084:Ultrasonography, Interventional