Background: Endoscopic ultrasonography (EUS) has become the investigation of choice
for the evaluation of the mediastinum. Lung and mediastinum are amongst the common
sites of metastases from renal cell cancer (RCC). We diagnosed metastatic RCC in mediastinal
lymph nodes by EUS-guided fine-needle aspiration (FNA) cytology.
Methods: A total of 111 patients with mediastinal lymph nodes had undergone EUS-FNA
using a linear array echo endoscope and a 170 cm, 22 G GIP needle consecutively. Smears
were prepared, air-dried, and sent to an independent cytologist.
Results: Seven patients (all males, mean age 64.8 years, range 45 - 72) were diagnosed
cytologically to have metastatic RCC. Three patients had been diagnosed with RCC in
the past (2,7, and 17 years ago) while in the others, this was primarily diagnosed
on the basis of EUS-FNA. The EUS features of these mediastinal RCC metastases include
irregular lesions with inhomogenous echotexture, measuring 2.8 cm (median; range 1.0
- 4.5) located predominantly in the posterior mediastinum.
Conclusion: EUS-FNA diagnosis of metastatic RCC is safe and feasible. It is especially
useful in the evaluation of the mediastinum for suspected metastases. Cytology examination
results in combination with clinical features could suggest the site of origin of
the primary, assisting in further management.
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A. Fritscher-Ravens, M.D.
Dept. of Interdisciplinary Endoscopy University Hospital Eppendorf
Martinistrasse 52 20246 Hamburg Germany
Fax: Fax:+ 49-40-42803-2405
eMail: E-mail:FRI-RAV@t-online.de
