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.
References
-
1
Bono A V, Lovisolo J AJ.
Renal cell carcinoma - diagnosis and treatment: state of the art.
Eur Urol.
1997;
31
47-55
-
2
Fritscher-Ravens A, Petrasch S, Reinacher-Schick A, et al.
Diagnostic value of endoscopic ultrasonography-guided fine-needle aspiration cytology of mediastinal masses in patients with intrapulmonary lesions and non diagnostic bronchoscopy.
Respiration.
1999;
515
150-155
-
3
Fritscher-Ravens A, Schirrow L, Atay Z, et al.
Endosonographisch gesteuerte Feinnadelaspirationszytologie - Indikationen und Ergebnisse in der Routinediagnostik.
Z Gastroenterol.
1999;
37
343-351
-
4
Chiles C, Ravin C E.
Intrathoracic metastasis from an extrathoracic malignancy: a radiographic approach to patient evaluation.
Radiol Clin N Am.
1985;
23
427-438
-
5
Merino D, Fishman E K.
Mediastinal adenopathy and endobronchial involvement in metastatic renal cell carcinoma.
J Comput Tomogr.
1988;
12
216-219
-
6
Hildebrandt U, Feifel G.
Endosonography in the diagnosis of lymph nodes.
Endoscopy.
1993;
25
243-245
-
7
Bhutani M S, Hawes R H, Hoffmann B J.
A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion.
Gastrointest Endosc.
1997;
45
474-479
-
8
Arita T, Kuramitsu T, Kawamura M, et al.
Bronchogenic carcinoma: Incidence of metastasis to normal sized lymph nodes.
Thorax.
1995;
50
1257-1269
-
9
Izbicki J R, Thetter O, Karg O, et al.
Accuracy of computed tomographic scan and surgical assessment for staging of bronchial carcinoma.
J Thorac Cardiovasc Surg.
1992;
104
413-420
-
10
Silvestri G A, Hoffmann B J, Bhutani M S, et al.
Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer.
Ann Thorac Surg.
1996;
61
1441-1446
-
11
Hughes J H, Jensen C S, Donnelly A D, et al.
The role of fine-needle aspiration cytology in the evaluation of metastatic clear cell tumors.
Cancer (Cancer Cytopathol).
1999;
87
380-389
-
12
Domagala W, Lasota J, Wolska H, et al.
Diagnosis of metastatic renal cell and thyroid carcinomas by intermediate filament typing and cytology of tumor cells in fine-needle aspirates.
Acta Cytol.
1988;
32
415-421
-
13
Beaty M W, Zhuang Z, Park W S, et al.
Fine-needle aspiration of metastatic clear cell carcinoma of the kidney: employment of microdissection and the polymerase chain reaction as a potential diagnostic tool.
Cancer.
1997;
81
180-186
-
14
Salazar A M, Westcott J L.
The role of transthoracic needle biopsy for the diagnosis and staging of lung cancer.
Clin Chest Med.
1993;
14
99-110
-
15
Gardner D, van Sonnenberg E, Dàgostino H B.
CT-guided trans-thoracic needle biopsy.
Cardiovasc Intervent Radiol.
1991;
14
17-23
-
16
Vilmann P, Hancke S, Henriksen F W, et al.
Endoscopic ultrasonography with guided fine-needle aspiration biopsy of malignant lesions in the upper gastrointestinal tract.
Endoscopy.
1993;
25
523-527
-
17
Wiersema M J, Vilmann P, Giovannini M, et al.
Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.
Gastroenterology.
1997;
112
1087-1095
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
