Percutaneous transhepatic intraportal biopsy using gastroscope biopsy forceps for diagnosis of a pancreatic neuroendocrine neoplasm:A case report

BACKGROUND Pancreatic neuroendocrine neoplasms(PNENs)are a rare group of neoplasms originating from the islets of the Langerhans.Portal vein tumor thrombosis has been reported in 33%of patients with PNENs.While the histopathological diagnosis of PNENs is usually based on percutaneous biopsy or endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA),these approaches may be impeded by gastric varices,poor access windows,or anatomically contiguous critical structures.Obtaining a pathological diagnosis using a gastroscope biopsy forceps via percutaneous transhepatic intravascular pathway is an innovative method that has rarely been reported.CASE SUMMARY A 72-year-old man was referred to our hospital for abdominal pain and melena.Abdominal contrast-enhanced magnetic resonance imaging revealed a wellenhanced tumor(size:2.4 cm×1.2 cm×1.2 cm)in the pancreatic tail with portal vein invasion.Traditional pathological diagnosis via EUS-FNA was not possible because of diffuse gastric varices.We performed a percutaneous transportal biopsy of the portal vein tumor thrombus using a gastroscope biopsy forceps.Histopathologic examination revealed a pancreatic neuroendocrine neoplasm(G2)with somatostatin receptors 2(+),allowing systemic treatment.CONCLUSION Intravascular biopsy using gastroscope biopsy forceps appears to be a safe and effective method for obtaining a histopathological diagnosis.Although welldesigned clinic trials are required to obtain more definitive evidence,this procedure may help improve the diagnosis of portal vein thrombosis and related diseases.

Percutaneous liver biopsy： retrospective study of primary and secondary hepatic lymphoma in twenty-one patients

BACKGROUND： Hepatic lymphoma （HL） is categorized as primary and secondary hepatic lymphoma （PHL and SHL）. This disorder can present as hepatic mass or mass-like lesion. Chemotherapy often is the first line treatment for patients with HL. Thus, an accurate pre-management histological diagnosis is essential to potentially improve clinical outcomes. The present study was to explore the prevalence of HL in ultrasound guided liver biopsies for hepatic mass or mass-like lesions, to investigate HL associated clinicopathological features, to raise the awareness of early recognition and proper diagnosis of this entity, and to assess specimen adequacy in needle core biopsy. METHODS： Twenty-one cases of HL were enrolled. Clinical and pathological characteristics were evaluated, quality of biopsies was assessed and pertinent literature was reviewed. RESULTS： HL was diagnosed in 0.94% of 2242 liver biopsy cases with ambiguous clinical presentation, laboratory tests and image studies. There were two cases of PHL （0.09%）, and nineteen cases of SHL （0.85%）. Histopathologically, diffuse large B-cell lymphoma was the most common type, followed by B-cell lymphoma not otherwise specified, T-ceU lymphoma, Hodgkin＇s lymphoma, and B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma. Additionally, three lym- phocytic infiltration patterns were documented microscopically. The nodular infiltration was the most common type. CONCLUSIONS： HL is a rare entity and histopathology along with ancillary tests remains the only way to make the diagnosis.Clinicians＇ awareness of this entity and early liver biopsy are essential in patient management.

Gallbladder polyp as a manifestation of hemobilia caused by arterial-portal fistula after percutaneous liver biopsy: A case report

Outpatient percutaneous liver biopsy is a common practice in the differential diagnosis and treatment of chronic liver disease. The major complication and mortality rate were about 2-4% and 0.01-0.33% respectively. Arterio-portal fistula as a complication of percutaneous liver biopsy was infrequently seen and normally asymptomatic. Hemobilia, which accounted for about 3% of overall major percutaneous liver biopsy complications, resulted rarely from arterio-portal fistula We report a hemobilia case of 68 years old woman who was admitted for abdominal pain after liver biopsy. The initial ultrasonography revealed a gallbladder polypoid tumor and common bile duct (CBD) dilatation. Blood clot was extracted as endoscopic retrograde cholangiopancreatography (ERCP) showed hemobilia. The patient was shortly readmitted because of recurrence of symptoms. A celiac angiography showed an intrahepatic arterio-portal fistula. After superselective embolization of the feeding artery, the patient was discharged uneventfully. Most cases of hemobilia caused by percutaneous liver biopsy resolved spontaneously. Selective angiography embolization or surgical intervention is reserved for patients who failed to respond to conservative treatment.

Delayed hemorrhage from hepatic artery after ultrasound-guided percutaneous liver biopsy: A case report

Percutaneous liver biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. Pseudoaneurysm of hepatic artery is an unusual complication after ultrasound-guided percutaneous liver biopsy. Delayed hemorrhage occurs much less frequently. We report a case of pseudoaneurysm of the hepatic artery of a 46-year-old man who was admitted for abdominal pain after 4 d of liver biopsy. The bleeding was controlled initially by angiographic embolization. However, recurrent bleeding could not be controlled by repeat angiography, and the patient died 4 d after admission from multiorgan failure. The admittedly rare possibility of delayed hemorrhage should be considered whenever a liver biopsy is performed.

Update on endoscopic ultrasound-guided liver biopsy

Endoscopic ultrasound guided liver biopsy(EUS-LB)has emerged as a minimally-invasive alternative to the traditional(percutaneous or transjugular)liver biopsy techniques for the diagnosis of liver parenchymal diseases.Potentially,EUS-LB combines the advantages of percutaneous and transjugular liver biopsy in addressing focused sampling in addition to measuring portal pressure.Additionally,EUS-LB facilitates access to both the lobes of the liver which is not considered with the traditional percutaneous liver biopsy.Multiple studies have compared EUS-LB with conventional liver biopsy and reported comparable diagnostic yield,increased acquisition of complete portal tracts,and longer specimen length as compared to the traditional approaches.EUS-LB is associated with lesser post-procedural pain and shorter recovery time,while providing lower risk of complications when compared to traditional liver biopsy.Innovations in needle types,needle sizes and suction techniques have aimed at further optimizing the EUS-LB technique.This review article updates current literature with focus on the variations in the technique and equipment used for EUS-LB,and compares EUS-LB with traditional methods of liver biopsy.

Endoscopic ultrasound guided liver biopsy: Recent evidence

Liver biopsy(LB)is an essential tool in diagnosing,evaluating and managing various diseases of the liver.As such,histopathological results are critical as they establish or aid in diagnosis,provide information on prognosis,and guide the appropriate selection of medical therapy for patients.Indications for LB include evaluation of persistent elevation of liver chemistries of unclear etiology,diagnosis of chronic liver diseases such as Wilson's disease,autoimmune hepatitis,small duct primary sclerosing cholangitis,work up of fever of unknown origin,amyloidosis and more.Traditionally,methods of acquiring liver tissue have included percutaneous LB(PCLB),transjugular LB(TJLB)or biopsy taken surgically via laparotomy or laparoscopy.However,traditional methods of LB may be inferior to newer methods.Additionally,PCLB and TJLB carry higher risks of adverse events and complications.More recently,endoscopic ultrasound guided LB(EUS-LB)has evolved as an alternative method of tissue sampling that has proven to be safe and effective,with limited adverse events.Compared to PC and TJ routes,EUS-LB may also have a greater diagnostic yield of tissue,be superior for a targeted approach of focal lesions,provide higher quality images and allow for greater patient comfort.These advantages have contributed to the increased use of EUS-LB as a technique for obtaining liver tissue.Herein,we provide a review of the recent evidence of EUS-LB for liver disease.

Two methods of lung biopsy for histological confirmation of acute fibrinous and organizing pneumonia:A case report

BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical manifestations of AFOP are nonspecific.Diagnosis depends on pathology.Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP.However,many patients have no tolerance to the operation,including mentally and physically.There is still no standard therapy for AFOP and the methods remain controversial.Therefore,further clinical attention and discussion are warranted.CASE SUMMARY A 53-year-old woman presented with fever,cough and dyspnea for 15 d.Antiinfective therapy was ineffective.Chest computed tomography showed bilateral patchy consolidation,especially in the lower lobes.We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations.Both samples supported the diagnosis of AFOP.The patient had a good clinical course after treatment with methylprednisolone,and no side effects of steroids.CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy.Methylprednisolone alone is effective in the treatment of idiopathic AFOP.

Post-Renal Biopsy Deglobulization: Risk Factors and Prognosis: A Study of 157 Biopsies

Introduction: Percutaneous renal biopsy (PRB) is the gold standard for the diagnosis of most renal diseases. It is a safe and effective modality for the collection of renal tissue. However, many safety measures are not based on sufficient evidence and therefore vary considerably from a center to another. The aim of this work is to determine the rate of bleeding complications, to identify the risk factors for these complications, and to clarify the post renal biopsy prognosis. Materials and Methods: We performed a single-center retrospective observational study in the nephrology department at the University Hospital of Fez, including all patients who underwent percutaneous renal biopsy on native kidney between January 2018 and December 2019. Results: Overall, 157 biopsies were performed. Deglobulization was present in 20.4% (40) of patients, the mean age of patients was 41.57 ± 16.11 years [16.78]. The sex ratio M/F: 1.22. Diabetes mellitus was present in four cases (11.1%), arterial hypertension was present in four cases (11.1%). On clinical examination, systolic hypertension was found in 45.7%, diastolic hypertension in 45%, antihypertensive therapy was initiated in all patients with hypertension before. Hyperuremia was present in 29 patients (80.6%), renal failure was present in 77.8%. Anemia was present in 55.6%, thrombocytopenia in six cases (16.7%). Radiologically, the size of the kidneys was reduced in 5 patients (17.2%), differentiation was limited in 5 patients (17.2%). Major complications occurred in 3.8% (6/157). These six patients had a lumbar pain and required blood transfusions. A radiological embolization procedure was indicated in only one patient. Minor complications were seen in 21.6% (34/157). The diagnoses that were retained in patients with deglobulization were: Lupus in 34.71%, pauci-immune vasculitis in 13.79%, membranous glomerulonephritis in 10.34%, focal and segmental hyalinosis in 10.34%, membrano-proliferative glomerulonephritis in 10.34%. In univariate and multivariate analysis, the major risk factors for deglobulization found in our patients were: hyperuremia 80.6% (p: 0.017), acute renal failure 77.8% (p: 0.04), acute hemodialysis 24.7% (p: 0.02), hyperphosphatemia 63.6% (0.04). Conclusion: Renal biopsies are an overall safe procedure with rare major complications. Post-renal biopsy deglobulization is common. Routine post-biopsy ultrasound may not be necessary. Renal biopsies can be performed safely if risk factors are controlled, such as renal failure, hyperuremia, hyperphosphatemia, hemodialysis patients and a diagnosis of lupus nephropathy.

Pulmonary benign metastasizing leiomyoma: A case report and review of the literature

BACKGROUND Pulmonary benign metastatic leiomyoma(PBML),which is very rare,is a type of benign metastatic leiomyoma(BML).Here,we report a case of PBML,finally diagnosed through multidisciplinary team(MDT)discussions,and provide a literature review of the disease.CASE SUMMARY A 55-year old asymptomatic woman was found to have bilateral multiple lung nodules on a chest high-resolution computed tomography(HRCT)scan.Her medical history included total hysterectomy for uterine leiomyoma.The patient was diagnosed with PBML,on the basis of her clinical history,imaging manifestations,and computed tomography(CT)-guided percutaneous lung puncture biopsy,via MDT discussions.As the patient was asymptomatic,she received long-term monitoring without treatment.A follow-up of chest HRCT after 6 mo showed that the PBML lung nodules were stable and there was no progression.CONCLUSION For patients with a medical history of hysterectomy and uterine leiomyoma with lung nodules on chest CT,PBML should be considered during diagnosis based on the clinical history,imaging manifestations,CT-guided percutaneous lung puncture biopsy,and MDT discussions.

RISK FACTORS OF CT-GUIDED PERCUTANEOUS LUNG BIOPSY COMPLICATIONS

Objective To evaluate the complication rate of CT-guided percutaneous lung biopsy and determine the risk factors for complications. MethodsA retrospective investigation of CT-guided percutaneous lung biopsy carried out between 2002 and 2009 was performed. The risk factors for complications were determined by multivariate analysis of variables related to patient demographics, lung lesions, and biopsy procedures. ResultsA total of 281 biopsy procedures were enrolled. The total complication rate was 55.9% with pneumothorax 32.4% (91/281) and bleeding 34.5% (97/281). The risk factors affecting pneumothorax rate were lesion location, lesion depth, and time of pleural pierce; and the risk factors affecting bleeding complications were lesion depth, lesion size, and age. Predictive models for pneumothorax and bleeding were established by logistic regression. The pneumothorax model had a sensitivity of 80.0% with a specificity of 62.4%,and the bleeding model had a sensitivity of 67.4% with a specificity of 88.8%. ConclusionLesion location, lesion depth, and number of pleural passes were independent risk factors for pneumothorax. Lesion size, lesion depth, and age were independent risk factor for bleeding. The predictive models for pneumothorax and bleeding will helpfully reduce the complication of CT-guided lung biopsy.

Hypercalcemia-Leukocytosis syndrome and adenosquamous lung carcinoma:An overlooked conjugation

Hypercalcaemia and leukocytosis are two paraneoplastic conditions associated with poor prognosis.Adenosquamous carcinoma is a rare and aggressive histological subtype of lung cancer consisting of adenocarcinoma and squamous cell components.We report the case of a 57-year-old male smoker who was admitted to the Emergency Room with skull and neck tumefactions,confusion and deteriorated general condition.The complementary study in the ER revealed severe hypercalcaemia(19.8 mg/dL),leukocytosis(18.7×10^(9)/L)and extensive osteolytic lesions of the skull on cranioencephalic computer tomography(CT).The patient was stabilized and admitted.Thoracoabdominopelvic CT showed lung parenchyma consolidation with necrotic areas,supra and infradiaphragmatic adenopathies and scattered osteolytic lesions.Percutaneous lymph node biopsy was consistent with metastasis of adenosquamous lung carcinoma.The patients’clinical situation evolved unfavourably after hospital-acquired infection.This case is characterized by a rare presentation of advanced stage adenosquamous lung carcinoma with scattered osteolytic lesions and severe hypercalcaemia-leukocytosis syndrome,an underrecognized marker of poor prognosis.

Diagnostic Value and Safety of CT and US-Guided PTNB for Peripheral Pulmonary Lesions: A Meta-Analysis and Clinical Study

Objective: To evaluate the diagnostic value and safety of CT and ultrasound-guided PTNB for peripheral type of occupying lung lesions by meta-analysis and clinical study. Methods: 1) The target data of randomized controlled trials of CT and ultrasound-guided PTNB for peripheral type of occupying lung lesions were extracted by computer search of foreign PubMed, Embase, the Cochrane Library, Web of Science databases, since the establishment of the database. Cochrane quality assessment criteria were used for evaluation. Statistical analysis was performed using Review Manager 5.3 software. 2) To retrospectively study the diagnosis rate and complication rate of patients, undergoing CT or ultrasound-guided PTNB in the First Affiliated Hospital of Dali University from January 2015 to December 2020. Results: Meta-analysis included 7 papers with a total of 1177 patients including 502 patients in the ultrasound group and 675 patients in the CT group. Meta-analysis results showed that there was no difference in the diagnosis rate of PTNB guided by ultrasound and CT. The incidence of postoperative complications was higher in the CT group than in the ultrasound group. The incidence of postoperative pneumothorax was higher in the CT group than in the ultrasound group, and there was no difference in the incidence of postoperative bleeding. 3) Clinical study results show that the puncture success rate was 100% in both of the ultrasound and CT groups, the pathological diagnosis rate was 85.48% in the ultrasound group and 91.67% in the CT group, and there was no difference in the overall complication rate between the two puncture groups. Conclusion: Either ultrasound or CT-guided PTNB is a safe and effective clinical diagnostic method for the diagnosis of peripheral pulmonary occupations.

Percutaneous Puncture Biopsy and Treatment Using Lo-cal Injection of Prednisolone for Solitary Esosinophilic Granuloma of the Skull.

The authors reported 8 cases of solitaty eosinophilic granuloma of the skull proved by percutaneous aspiration biopsy and treated with local prednisolone injection under fluoroscopic guidance and palpation with excellent results.