- Email: [email protected]
Recurrent malignant thymoma diagnosed by EUS-guided Trucut biopsy
At the Focal Point
Recurrent malignant thymoma diagnosed by EUS-guided Trucut biopsy
A 70-year-old woman with a history of malignant thymoma, which was resected and treated with radiation therapy in 1998, was referred 6 years later for EUS evaluation of a suspicious lesion in the posterior mediastinum detected at surveillance CT. EUS demonstrated 2 hypoechoic, heterogeneous masses in the posterior mediastinal region, which measured 20 10 mm and 15 13 mm. EUS-guided FNA was then performed, with a 22-gauge needle (Echotip Ultra; Cook Endoscopy, Winston-Salem, NC), for a total of 5 passes in each of the lesions. EUS-guided tru-cut biopsy (EUS-TCB) of the distal lesion was also performed by using the 19-gauge Quick-Core device (Cook Endoscopy) (A). The FNA specimens obtained from both lesions showed lymphoid cells and were classified as negative for malignancy.
In contrast, histopathologic examination of the tissue sample demonstrated the presence of scattered neoplastic epithelioid cells within a dense infiltrate of lymphocytes (B; H&E, orig. mag. 200). These cells showed strong positive immunoreactivity for keratin CAM 5.2 by immunohistochemistry (C; CAM 5.2, orig. mag. 200), while the surrounding lymphocytes stained with antibodies directed against CD5, a marker of T cells (D; CD5, orig. mag. 400). The histologic and immunohistochemical features were diagnostic of recurrent thymic carcinoma. Alberto Larghi, MD, PhD, Unita` Operativa di Endoscopia Digestiva, Policlinico A. Gemelli, Rome, Italy; Erika RodriguezWulff, MD, Amy Noffsinger, MD, Charles E. Dye, MD, Section of Endoscopy and Therapeutics, Department of Pathology, The University of Chicago, Chicago, Illinois, USA
Erika Rodriguez-Wulff is supported by the Don Wilson Award 2005.
doi:10.1016/j.gie.2005.10.019
www.giejournal.org
Volume 63, No. 6 : 2006 GASTROINTESTINAL ENDOSCOPY 859
At the Focal Point
Commentary The thymus gland involutes with aging and an enlarged thymus gland must be defined in individuals of this patient’s age. Thymoma is the most common tumor of the anterior superior mediastinum and is associated with myasthenia gravis and rarely with acquired hypogammaglobulinemia. Thymic neoplasms also include lymphoma, carcinoid, and germ cell tumors, so accurate diagnosis is important. EUS-TCB is a useful technique when lesions cannot be diagnosed by cytology alone. Lawrence J. Brandt, MD Associate Editor of Focal Points
Gastric piercing
A 40-year-old woman was admitted because of she accidentally swallowed a foreign object (metallic pin) while she was knitting the day before. She was asymptomatic
and had no evidence of complications. Chest and abdominal radiographs were taken. A metallic pin was observed on the plain film of the abdomen at the epigastrium. Three
860 GASTROINTESTINAL ENDOSCOPY Volume 63, No. 6 : 2006
www.giejournal.org
Recurrent malignant thymoma diagnosed by EUS-guided Trucut biopsy
A 70-year-old woman with a history of malignant thymoma, which was resected and treated with radiation therapy in 1998, was referred 6 years later for EUS evaluation of a suspicious lesion in the posterior mediastinum detected at surveillance CT. EUS demonstrated 2 hypoechoic, heterogeneous masses in the posterior mediastinal region, which measured 20 10 mm and 15 13 mm. EUS-guided FNA was then performed, with a 22-gauge needle (Echotip Ultra; Cook Endoscopy, Winston-Salem, NC), for a total of 5 passes in each of the lesions. EUS-guided tru-cut biopsy (EUS-TCB) of the distal lesion was also performed by using the 19-gauge Quick-Core device (Cook Endoscopy) (A). The FNA specimens obtained from both lesions showed lymphoid cells and were classified as negative for malignancy.
In contrast, histopathologic examination of the tissue sample demonstrated the presence of scattered neoplastic epithelioid cells within a dense infiltrate of lymphocytes (B; H&E, orig. mag. 200). These cells showed strong positive immunoreactivity for keratin CAM 5.2 by immunohistochemistry (C; CAM 5.2, orig. mag. 200), while the surrounding lymphocytes stained with antibodies directed against CD5, a marker of T cells (D; CD5, orig. mag. 400). The histologic and immunohistochemical features were diagnostic of recurrent thymic carcinoma. Alberto Larghi, MD, PhD, Unita` Operativa di Endoscopia Digestiva, Policlinico A. Gemelli, Rome, Italy; Erika RodriguezWulff, MD, Amy Noffsinger, MD, Charles E. Dye, MD, Section of Endoscopy and Therapeutics, Department of Pathology, The University of Chicago, Chicago, Illinois, USA
Erika Rodriguez-Wulff is supported by the Don Wilson Award 2005.
doi:10.1016/j.gie.2005.10.019
www.giejournal.org
Volume 63, No. 6 : 2006 GASTROINTESTINAL ENDOSCOPY 859
At the Focal Point
Commentary The thymus gland involutes with aging and an enlarged thymus gland must be defined in individuals of this patient’s age. Thymoma is the most common tumor of the anterior superior mediastinum and is associated with myasthenia gravis and rarely with acquired hypogammaglobulinemia. Thymic neoplasms also include lymphoma, carcinoid, and germ cell tumors, so accurate diagnosis is important. EUS-TCB is a useful technique when lesions cannot be diagnosed by cytology alone. Lawrence J. Brandt, MD Associate Editor of Focal Points
Gastric piercing
A 40-year-old woman was admitted because of she accidentally swallowed a foreign object (metallic pin) while she was knitting the day before. She was asymptomatic
and had no evidence of complications. Chest and abdominal radiographs were taken. A metallic pin was observed on the plain film of the abdomen at the epigastrium. Three
860 GASTROINTESTINAL ENDOSCOPY Volume 63, No. 6 : 2006
www.giejournal.org