scholarly journals P6‐18: Endobronchial ultrasound transbronchial aspiration biopsy (EBUS‐TBNA) in the diagnosis of mediastinal mass of unknown etiology: A case series

Respirology ◽  
2021 ◽  
Vol 26 (S3) ◽  
pp. 232-232
2013 ◽  
Vol 66 (suppl. 1) ◽  
pp. 17-21
Author(s):  
Spasoje Popevic ◽  
Emilija Bukurov-Sudjic ◽  
Zivka Uskokovic-Stefanovic ◽  
Aleksandra Dudvarski-Ilic ◽  
Mihailo Stjepanovic ◽  
...  

Introduction. Sarcoidosis is a multisystem disease of unknown etiology characterized by the presence of non-caseating granulomas in the affected tissues and organs. In most cases, biopsy of available lesions and histological verification is required, which makes bronchoscopy a method of choice in invasive diagnostics of sarcoidosis. Due to the construction of the bronchoscope and biopsy instruments, high quality tissue samples can be obtained from different anatomic locations. Transbronchial lung biopsy. Transbronchial lung biopsy with forceps represents a standard in diagnostics of sarcoidosis and it is always performed during bronchoscopy. Sensitivity and specificity of this method are rising with the stage of disease and it is performed even if chest radiography shows no changes in lung parenchyma. Endoscopic finding in sarcoidosis and endobronchial biopsy (biopsy of bronchial mucosa). Endobronchial biopsy results in diagnosis in 70% of patients with sarcoidosis and positivity is even higher when combined with transbronchial lung biopsy (76-86%). Transbronchial needle aspiration biopsy. Transbronchial needle aspiration biopsy is a safe and widely used routine method, especially if sarcoidosis is in stages I and II. Higher positivity and better quality of biopsy samples can be achieved when transbronchial needle aspiration biopsy is guided by the endobronchial ultrasound. Bronchoalveolar lavage. The significance of bronchoalveolar lavage remains controversial and subjected to further clinical investigations. Conclusion. All presented data point out that all biopsy techniques available should be used during fiberoptic bronchoscopy under suspicion of sarcoidosis, regardless of radiographic and endoscopic appearances.


2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Sara Lomelino Pinheiro ◽  
Inês Damásio ◽  
Ana Figueiredo ◽  
Tiago Nunes da Silva ◽  
Valeriano Leite

Background. Mediastinal thyroid carcinoma is extremely rare, with few cases reported in the literature. Case Report. A 73-year-old man presented with weight loss for 6 months. Imaging by computed tomography (CT) documented a large mediastinal mass below the thyroid gland and pulmonary metastases. Neck ultrasound found two spongiform nodules in the right thyroid lobe, and fine-needle aspiration citology (FNAC) of these nodules revealed they are benign. Endobronchial ultrasound-guided needle biopsy of the mediastinal mass was compatible with papillary thyroid cancer. A few weeks later, the patient developed overt hyperthyroidism due to Graves’ disease, which was treated with antithyroid drugs. 99mPertechnetate scintigraphy showed increased diffuse uptake in the thyroid parenchyma but the absence of uptake in the paratracheal mass and in the lung nodules. The patient was not considered eligible for surgical intervention or therapy with tyrosine kinase inhibitor due to tracheal and mediastinal vessel invasion and was treated with palliative radiotherapy. Two months later, restaging PET-FDG showed an intense uptake in the right lobe of the thyroid gland, lymph nodes, lungs, bone, muscle, myocardial, kidney, and adrenal gland. Conclusion. In this case, thyroid carcinoma presented as a mediastinal mass with concurrent hyperthyroidism due to Graves’ disease. Although uncommon, the clinicians should be aware of these situations. Obtaining a prompt histological examination of an intrathoracic mass is crucial to ensure an early diagnosis and treatment.


CytoJournal ◽  
2014 ◽  
Vol 11 ◽  
pp. 19 ◽  
Author(s):  
Emad Raddaoui ◽  
Esam H Alhamad ◽  
Shaesta Naseem Zaidi ◽  
Fatmah F Al-Habeeb ◽  
Maha Arafah

Objective: The objective of this study is to evaluate the cytological accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TFNA) of the mediastinal mass/nodular lesions. Study Design: Over 3½ years from inception at King Khalid University Hospital, a retrospective analysis of the cytological diagnoses of all the EBUS-TFNA procedures performed in 80 patients who had mediastinal mass/nodular enlargement. Cytology results were reviewed and correlated with the histologic follow-up. Results: Of the 80 patients who underwent EBUS-TFNA, 15 cases (18.75%) were positive for malignancy, 48 cases (60%) negative for malignancy and 17 cases (21.25%) unsatisfactory. Of the 48 cases, which were negative for malignancy, 24 (50%) cases were of granulomatous inflammation. The overall diagnostic yield of our EBUS-TFNA specimen was 78.75%. Forty-seven cases (58.75%) of 80 cases had histological follow-up biopsies. Among them, 32 cases (68%) had the same cytological and histological diagnosis and 15 cases (31.09%) had discordance between the cytology and the follow-up histological diagnosis. The sensitivity, specificity, and positive and negative predictive values for diagnosing granulomas by EBUS-TFNA are 77%, 82%, 83%, and 75% and for diagnosing malignancy are 71%, 100%, 100%, and 82%, respectively. Conclusion: Preliminary results show that cytological samples obtained through EBUS-TFNA are accurate and specific in making a diagnosis of the mediastinal mass/nodular lesions. Its optimum use depends on the effective collaboration between the cytotechnologist, pathologist, and the bronchoscopist.


2020 ◽  
pp. 107110072097096
Author(s):  
Ivan Bojanić ◽  
Mihovil Plečko ◽  
Ana Mataić ◽  
Damjan Dimnjaković

Background: Primary synovial chondromatosis (PSC) is a progressive disorder of unknown etiology resulting in formation of multiple loose bodies. If left untreated, it may lead to degenerative changes or malignant transformation to chondrosarcoma. Methods: Seventeen patients who underwent combined posterior and anterior ankle arthroscopy within the same operative session and had histologically confirmed PSC were included in this retrospective study. American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score was used to evaluate ankle function preoperatively and at a final follow-up. A 3-question survey was used to evaluate patient’s satisfaction at the final follow-up. Results: In 14 patients, loose bodies were found in both compartments of the ankle, in 2 only in the anterior compartment, and in 1 only in the posterior compartment. All patients had evident signs of synovial inflammation in both compartments. The AOFAS Ankle-Hindfoot score increased from the preoperative median score of 65 (range, 29-90) to 95 (range, 65-100) at the final follow-up. Fourteen patients reported they were extremely satisfied with the outcome, 1 was moderately satisfied, and 2 were dissatisfied. No cases of recurrence of synovitis or loose body formation were noted, nor any signs of malignant transformation during the follow-up period. Conclusion: We believe the risk of recurrence of PSC, which is in close relation to malignant transformation, can be minimized by performing a complete synovectomy of the ankle. Our experience and review of literature makes us believe that ankle PSC should be regarded as a whole joint disorder. Performing a combined posterior and anterior arthroscopic procedure within the same operative session should always be considered in patients with ankle PSC. Level of Evidence: Level IV, retrospective case series.


Endoscopy ◽  
2009 ◽  
Vol 41 (02) ◽  
pp. 179-182 ◽  
Author(s):  
T. Iwashita ◽  
I. Yasuda ◽  
H. Tsurumi ◽  
N. Goto ◽  
M. Nakashima ◽  
...  

2020 ◽  
Vol 9 (4) ◽  
pp. 1081 ◽  
Author(s):  
Rashi Jain ◽  
Dhananjay Yadav ◽  
Nidhi Puranik ◽  
Randeep Guleria ◽  
Jun-O Jin

Sarcoidosis is a multisystem granulomatous disease with nonspecific clinical manifestations that commonly affects the pulmonary system and other organs including the eyes, skin, liver, spleen, and lymph nodes. Sarcoidosis usually presents with persistent dry cough, eye and skin manifestations, weight loss, fatigue, night sweats, and erythema nodosum. Sarcoidosis is not influenced by sex or age, although it is more common in adults (< 50 years) of African-American or Scandinavians decent. Diagnosis can be difficult because of nonspecific symptoms and can only be verified following histopathological examination. Various factors, including infection, genetic predisposition, and environmental factors, are involved in the pathology of sarcoidosis. Exposures to insecticides, herbicides, bioaerosols, and agricultural employment are also associated with an increased risk for sarcoidosis. Due to its unknown etiology, early diagnosis and detection are difficult; however, the advent of advanced technologies, such as endobronchial ultrasound-guided biopsy, high-resolution computed tomography, magnetic resonance imaging, and 18F-fluorodeoxyglucose positron emission tomography has improved our ability to reliably diagnose this condition and accurately forecast its prognosis. This review discusses the causes and clinical features of sarcoidosis, and the improvements made in its prognosis, therapeutic management, and the recent discovery of potential biomarkers associated with the diagnostic assay used for sarcoidosis confirmation.


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