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| IMAGES AND VIDEOS |
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| Year : 2021 | Volume
: 10
| Issue : 1 | Page : 71-72 |
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EUS-FNA of portal venous tumoral thrombosis for diagnosis of hepatocellular carcinoma without primary hepatic mass (with video)
Ludivine Gan, Fanny Houser, Thomas Di Bernardo, Aude Le Goffic, Philippe Ah-Soune
Department of Gastroenterology, Hôpital Sainte Musse, Toulon, France
| Date of Submission | 14-May-2020 |
| Date of Acceptance | 25-Aug-2020 |
| Date of Web Publication | 05-Jan-2021 |
Correspondence Address:
Dr. Philippe Ah-Soune
Hôpital Sainte Musse, Toulon
France
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/eus.eus_64_20
How to cite this article:
Gan L, Houser F, Di Bernardo T, Le Goffic A, Ah-Soune P. EUS-FNA of portal venous tumoral thrombosis for diagnosis of hepatocellular carcinoma without primary hepatic mass (with video). Endosc Ultrasound 2021;10:71-2 |
How to cite this URL:
Gan L, Houser F, Di Bernardo T, Le Goffic A, Ah-Soune P. EUS-FNA of portal venous tumoral thrombosis for diagnosis of hepatocellular carcinoma without primary hepatic mass (with video). Endosc Ultrasound [serial online] 2021 [cited 2021 Mar 2];10:71-2. Available from: http://www.eusjournal.com/text.asp?2021/10/1/71/306173 |
Malignant portal venous thrombosis (PVT) is associated with a poor prognosis in patients with hepatocellular carcinoma (HCC), and its presence contraindicates both surgical resection and liver transplantation. Studies have shown that when technically feasible, confirming the malignancy of PVT associated with an intrahepatic mass suggestive of HCC enables more accurate staging and has an impact on subsequent treatments.[1],[2] Few cases of HCC presenting as isolated malignant PVT have been described.[3]
To obtain histological proof, EUS-FNA on the tumoral PVT is a safe and effective procedure[4],[5] as the echoendoscope is closer to the PVT, and the high frequency provides an excellent resolution and reliable visualization of the portal vein, its content, and the surrounding tissue and organs. Moreover, the FNA needle only travels a short distance, making the procedure quick and precise.[4]
We present a video of EUS-FNA of an isolated tumoral PVT revealed by a variceal bleeding in a 68-year-old man with known postalcoholic cirrhosis Child-Pugh A6. Computed tomography scan and magnetic resonance imaging showed PVT extending from the upper mesenteric vein to the left branch of the portal vein, measuring 37 mm in diameter, with malignant features including arterial enhancement and rapid wash-out of the thrombus. There was no evidence of a primary intrahepatic mass [Figure 1] and [Video 1].
The intervention was performed under general anaesthesia. EUS showed hyperechoic PVT extending to the left portal branch, with pathognomonic intrathrombus pulsatile flow. EUS-FNA was obtained after two passes with a 22G needle and continuous suction with a syringe. No adverse events were reported. The diagnosis of HCC was confirmed after pathological examination (liquid-based cytology and immunocytochemistry on cell block preparation).
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his names and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Michael H, Lenza C, Gupta M, et al . Endoscopic ultrasound-guided fine-needle aspiration of a portal vein thrombus to aid in the diagnosis and staging of hepatocellular carcinoma. Gastroenterol Hepatol (N Y) 2011;7:124-9.  |
| 2. | Lai R, Stephens V, Bardales R. Diagnosis and staging of hepatocellular carcinoma by EUS-FNA of a portal vein thrombus. Gastrointest Endosc 2004;59:574-7. |
| 3. | Poddar N, Avezbakiyev B, He Z, et al . Hepatocellular carcinoma presenting as an incidental isolated malignant portal vein thrombosis. J Gastrointest Canc 2012;43:486. |
| 4. | Kantsevoy S, Thuluvath PJ. Utility and safety of EUS-guided portal vein FNA. Gastroenterol Hepatol (N Y) 2011;7:129-31. |
| 5. | Kayar Y, Turkdogan KA, Baysal B, et al . EUS-guided FNA of a portal vein thrombus in hepatocellular carcinoma. Pan Afr Med J 2015;21:86. |
[Figure 1]
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