title: EUS-guided fine needle tissue acquisition for the diagnosis of pleural metastases from endometrial cancer.
abstract: Transesophageal EUS-FNA have become a useful tool in the evaluation of the mediastinum, especially during the staging work-up examination of patients with non-small-cell lung cancer (NSCLC) or other malignancies. We report a challenging case of a 53 years-old woman with an endometrial adenocarcinoma who subsequently presented with right pleural effusion, diffuse pleural thickening with few pleural lesions. The patient referred a long history of exposure to amiantum, this posing a differential diagnosis between primary pleural tumour (mesothelioma) and neoplastic pleural localization of the endometrial cancer. The cytological examination of the pleural effusion (sampled via thoracenthesis) was not adequate to reach a diagnosis. Although a right-video-assisted thoracoscopy was considered the gold standard in this clinical setting to achieve a tissue acquisition of the pleura, an EUS (as the least invasive procedure) was attempted to reach a definitive diagnosis. EUS-FNTA of the pleura was done using a 19-Gauge needle and the pathological and immunophenotypic features were diagnostic for a pleural metastasis of high-grade endometrial serous carcinoma. The patient received adjuvant chemotherapy with a complete regression of the pleural lesions. We take the opportunity of this challenging case to discuss the efficacy and safety of EUS-FNAT to sample the pleural lesions with the use of a large calibre needle if the lesion lies just under the EUS cursor. We may assume that, in selected patients, this technique could be presented as a viable option to the more invasive surgical procedure, which has been previously the gold standard for the pleural tissue acquisition.
authors.affiliation: Digestive Endoscopy Unit, Thoracic Surgery, Division of Gynecologic Oncology, and Institute of Pathology, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy. filippo_lococo@yahoo.it.
authors.forename: A
authors.initials: A
authors.lastname: Larghi
authors.forename: F
authors.initials: F
authors.lastname: Lococo
authors.forename: S
authors.initials: S
authors.lastname: Mainenti
authors.forename: G
authors.initials: G
authors.lastname: Petrone
authors.forename: A
authors.initials: A
authors.lastname: Cesario
authors.forename: P
authors.initials: P
authors.lastname: Granone
authors.forename: G
authors.initials: G
authors.lastname: Scambia
authors.forename: G
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D000230:Adenocarcinoma / Q000737:chemistry / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D016190:Carboplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D016889:Endometrial Neoplasms / Q000737:chemistry / Q000473:pathology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D060787:Neoplasm Grading; D016066:Pleural Effusion, Malignant / Q000209:etiology; D010997:Pleural Neoplasms / Q000737:chemistry / Q000150:complications / Q000188:drug therapy / Q000556:secondary*; D011092:Polyethylene Glycols / Q000008:administration & dosage; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; C506643:liposomal doxorubicin; D011092:Polyethylene Glycols; D004317:Doxorubicin; D016190:Carboplatin