Intimal angiosarcoma of the thoracic aorta diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration: a case report.

BACKGROUND: Primary malignant tumors of the aorta are extremely rare. They are frequently located in the abdominal aorta, followed by the thoracic aorta. Sarcomas are the most common histological type. These tumors originate from the middle or intimal layer, the latter being the most common. Symptoms and radiological findings are generally nonspecific. Since their growth is endovascular, embolic phenomena can occur leading to occlusive signs and symptoms. CASE PRESENTATION: We describe the case of a 75-year-old Hispanic man, a former tobacco smoker, with a history of pain and epigastric tenderness, dysphagia, and weight loss of approximately 6 kg. A thorax computed tomography scan showed a mass within the posterior mediastinum with poorly defined borders and heterogeneous density, located between thoracic vertebra 5-8, with a size of 78 × 53 × 76 mm, with left main bronchus compression. Endobronchial ultrasound-guided transbronchial needle aspiration was performed; it found an extrinsic posterior compression of the left main bronchus with no endobronchial injury. An intimal angiosarcoma of the thoracic aorta was diagnosed. CONCLUSION: Tumors of the aorta are rare and difficult to diagnose; they are a challenge during the diagnosis, since they usually require open surgical procedures. Endobronchial ultrasound-guided transbronchial needle aspiration associated with rapid on-site examination offered, in this case, the possibility of a successful diagnosis, avoiding major procedures. This is the first case reported in the literature of an intimal angiosarcoma of the thoracic aorta diagnosed using endobronchial ultrasound-guided transbronchial needle aspiration.

Endobronchial ultrasound-guided transbronchial needle aspirate for diagnosis of anaplastic large cell lymphoma of unusual presentation: A case report.

Anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin lymphoma (NHL) originated from mature post thymic T cells. They represent 1-3% of NHL. Different subtypes have been described: Anaplastic lymphoma kinase (ALK)-negative ALCL, ALK-positive ALCL and breast implant-associated ALCL. ALK-positive ALCL affects mainly the young and has better prognosis. We present a case report of an adult woman with AKL-positive ALCL, diagnosed by endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA). A 59-year-old women with no history of breast implants, was admitted for a four-month low back pain. Initially, the patient was treated for a spondyloarthropathy, but due to persistence of the symptoms, a lumbosacral MRI was performed, showing changes in morphology and signal intensity in the vertebral body of L3, along with edema and a paravertebral collection that affected the left psoas muscle, suggesting granulomatous spondylodiscitis. Chest CT-scan showed mild left pleural effusion, subcarinal and right hiliar adenomegalies. An EBUS-TBNA with ROSE (rapid on-site evaluation) was performed showing positive findings for malignancy, suggestive of hematolymphoid neoplasia. Pathology analysis showed an AKL-positive ALCL. Additionally, a biopsy of paravertebral tissue biopsy was obtained, which was consistent with the nodal sample. Chemotherapy was initiated with the CHOP protocol: cyclophosphamide, hydroxydaunorubicin, vincristine sulfate and prednisone. EBUS-TBNA is a minimally invasive and safe technique for obtaining mediastinal samples. Collaboration with a cytopathologist trained to perform ROSE improves the diagnostic performance.

Diagnostic Accuracy of Endobronchial Ultrasound Transbronchial Needle Aspiration in Lymphoma. A Systematic Review and Meta-Analysis.

Rationale: Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method used to diagnose suspected mediastinal lymph nodes or masses. However, the accuracy of the diagnosis in patients with suspected lymphoma is unclear.Objectives: To evaluate the diagnostic yield of EBUS-TBNA in patients with suspected lymphoma.Methods: A literature search including EMBASE, MEDLINE, Cochrane Library, and Google Scholar was performed by two reviewers. Included articles were evaluated using the QUADAS-2 tool and meta-analysis with a binary method model to compare the sensitivity, specificity, and summary receiver operating characteristic curve in patients with suspected lymphoma.Results: Fourteen studies (425 participants) were pooled in the analysis. EBUS-TBNA reported an overall sensitivity of 66.2% (confidence interval [CI], 55-75.8%; I2 = 76.2%) and specificity of 99.3% (CI, 98.2-99.7%; I2 = 40%). For a new diagnosis of lymphoma, 13 studies including 243 participants reported sensitivity of 67.1% (CI, 54.2-77.9%; I2 = 66.8%) and specificity of 99.6% (CI, 99.1-99.8%; I2 = 0%). For recurrence of lymphoma, 11 studies including 166 participants reported sensitivity of 77.8% (CI, 68.1-85.2%; I2 = 20.2%) and specificity of 99.5% (CI, 98.9-99.8%; I2 = 0%). In the recurrence group, we found the use of rapid onsite examination, sample size, and flow cytometry increased the sensitivity of EBUS-TBNA, albeit a potential source of heterogeneity.Conclusions: EBUS-TBNA has fair sensitivity for identifying a new diagnosis of lymphoma and fair to good sensitivity for identifying recurrence.Trial Registry: PROSPERO CRD42018102773 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=102773.

Utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with rapid on-site evaluation (ROSE) for the molecular classification of progressive breast cancer / Utilidad de la aspiración transbronquial con aguja guiada por ultrasonido endobronquial con evaluación rápida in situ para la clasificación de cáncer de mama progresivo

Abstract Evidence of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in extrathoracic malignancy is limited but emergent. The technique plays a vital role in the diagnosis of mediastinal lesions, staging, and restaging of lung cancer. Its usefulness for the evaluation and molecular classification of progressive breast cancer is described in 7 patients. Stations 7, 11L, and 11R were punctured. Cellblocks, immunohistochemistry and digital analysis were developed in 100% of the cases for molecular classification. This procedure requires multidisciplinary evaluation, image analysis, and evaluation of the general condition of the patient, as well as the risks and benefits. Additionally, it is essential teamwork with a pathology group that performs the rapid on-site evaluation (ROSE), in order to ensure the quality of the samples and molecular characterization.

Resumen Evidencia de la aspiración transbronquial con aguja guiada por ultrasonido endobronquial en malignidad extratorácica es limitada pero emergente. Esta técnica desempeña un papel vital en el diagnóstico de lesiones mediastinales, estadificación y reestadificación del cáncer pulmonar. Se describe su utilidad para la evaluación y la clasificación molecular del cáncer de mama en progresión de siete pacientes. Se puncionaron las estaciones (ganglionares) 7, 11L y 11R. Se desarrollaron bloques celulares, inmunohistoquímica y análisis digital en el 100% de los casos para clasificación molecular. Este procedimiento requiere una evaluación multidisciplinaria, análisis de imágenes y la evaluación del estado general de la paciente, lo mismo que los riesgos y los beneficios. Adicionalmente, es esencial el trabajo conjunto con un grupo de patología que realice la evaluación rápida en sala (ROSE), para así asegurar la calidad de las muestras y la caracterización molecular.

A rare case of mediastinal metastasis of ovarian carcinoma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a minimally invasive tool with excellent diagnostic accuracy and low risk of complications in the diagnosis of thoracic diseases, including lung cancers and primary mediastinal lesions. Occasionally, EBUS-TBNA may be useful in identifying thoracic metastasis from distant tumors. Here we report an interesting and rare case of mediastinal metastasis of ovarian carcinoma diagnosed by EBUS-TBNA.

Tracheobronchial Tuberculosis Without Lung Involvement.

Endotracheal tuberculosis (ETTB) is an infrequent form of tuberculosis whose major feature is the infection of the tracheobronchial tree by Mycobacterium tuberculosis. This case presents a 73-year-old man admitted to our hospital with fatigue, weakness, dry cough and weight loss. His chest X-ray was normal but the high resolution computed tomography (HRCT) showed normal parenchyma images with mediastinal and hilar lymphadenopathy. There was inflammation of the tracheal wall and infiltrates in pavement epithelium; however, the tracheal biopsy for acid-fast bacilli was negative. He was finally diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the lymph nodes. Four drugs were prescribed and symptoms improved. EBUS-TBNA contributed to prompt diagnosis. The patient was treated and evolved without complications, such as tracheal stenosis.