Endoscopic Ultrasound Through-the-Needle Biopsy for the Diagnosis of an Abdominal Bronchogenic Cyst

Cassiani, Jessica; Crinò, Stefano Francesco; Manfrin, Erminia; Rivelli, Matteo; Gabbrielli, Armando; Guglielmi, Alfredo; Pedrazzani, Corrado

doi:.0.0.0

Clin Endosc > Epub ahead of print

Case Report

Endoscopic Ultrasound Through-the-Needle Biopsy for the Diagnosis of an Abdominal Bronchogenic Cyst

Jessica Cassiani¹

, Stefano Francesco Crinò²

, Erminia Manfrin³

, Matteo Rivelli¹

, Armando Gabbrielli²

, Alfredo Guglielmi¹

, Corrado Pedrazzani¹

¹Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona Hospital Trust, University of Verona, Verona, Italy
²Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona Hospital Trust, University of Verona, Verona, Italy
³Department of Diagnostic and Public Health, University of Verona Hospital Trust, University of Verona, Verona, Italy

Correspondence :

Stefano Francesco Crinò ,Tel: +39-045-812-6191, Fax: +39-045-812-8191, Email: stefanocrino@hotmail.com

Received: July 22, 2020 Revised: September 15, 2020 Accepted: October 17, 2020

Abstract

A 57-year-old woman with epigastric pain was diagnosed with a 6-cm abdominal cystic lesion of unclear origin on cross-sectional imaging. Endoscopic ultrasound (EUS) demonstrated a unilocular cyst located between the pancreas, gastric wall, and left adrenal gland, with a regular wall filled with dense fluid with multiple hyperechoic floating spots. A 19-G needle was used to puncture the cyst, but no fluid could be aspirated. Therefore, EUS-guided through-the-needle biopsy (EUS-TTNB) was performed. Histological analysis of the retrieved fragments revealed a fibrous wall lined by “respiratory-type” epithelium with ciliated columnar cells, consistent with the diagnosis of a bronchogenic cyst. Laparoscopic excision was performed, and the diagnosis was confirmed based on the findings of the surgical specimen. Abdominal bronchogenic cysts are extremely uncommon, and a definitive diagnosis is commonly obtained after the examination of surgical specimens due to the lack of pathognomonic findings on cross-sectional imaging and poor cellularity on EUS-guided fine-needle aspiration cytology. EUS-TTNB is useful for establishing a preoperative histological diagnosis, thus supporting the decision-making process.

Key Words: Bronchogenic cyst; Endoscopic ultrasound-guided fine needle aspiration; Endoscopic ultrasound-guided through-the-needle biopsy; Laparoscopy; Pancreatic cyst