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.

Endobiliary biopsy

The differential diagnosis between benign and malignant biliary strictures is challenging and requires a multidisciplinary approach with the use of serum biomarkers,imaging techniques,and several modalities of endoscopic or percutaneous tissue sampling.The diagnosis of biliary strictures consists of laboratory markers,and invasive and non-invasive imaging examinations such as computed tomography(CT),contrast-enhanced magnetic resonance cholangiopancreatography,and endoscopic ultrasonography(EUS).Nevertheless,invasive imaging modalities combined with tissue sampling are usually required to confirm the diagnosis of suspected malignant biliary strictures,while pathological diagnosis is mandatory to decide the optimal therapeutic strategy.Although EUS-guided fine-needle aspiration biopsy is currently the standard procedure for tissue sampling of solid pancreatic mass lesions,its diagnostic value in intraductal infiltrating type of cholangiocarcinoma remains limited.Moreover,the“endobiliary approach”using novel slim biopsy forceps,transpapillary and percutaneous cholangioscopy,and intraductal ultrasound-guided biopsy,is gaining ground on traditional endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography endobiliary forceps biopsy.This review focuses on the available endobiliary techniques currently used to perform biliary strictures biopsy,comparing the diagnostic performance of endoscopic and percutaneous approaches.

Sarcomatoid malignant pleural mesothelioma confirmed by full-thickness biopsy

Diffuse malignant pleural mesothelioma （DMPM） is a rare thoracic malignancy, but its incidence isdramatically increasing worldwide as a result ot widespread use of asbestos. The World Health Organization classifies DMPM into three types： epithelioid, sarcomatoid, and biphasic types. DMPM remains suffering poor prognosis and the diagnosis should always be based on adequate, representative tissue samples. There still remains a considerable number of patients with DMPM who are misdiagnosed after a complete investigation including thoracoscopic biopsies.