Role of transduodenal endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) for diagnosis of retroperitoneal fibrosis (Ormond’s disease)

Abstract

Background Retroperitoneal fibrosis (RPF), often referred to as Ormond’s disease when it is of idiopathic origin, is a rare disease characterized by the presence of inflammatory infiltrates and periaortic masses in the retroperitoneum. For a definite diagnosis, a biopsy and subsequent pathological examination is required. Currently accepted methods for retroperitoneal biopsy include open, laparoscopic, or CT-guided approaches. However, transduodenal endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) for diagnosis of RPF has attracted only little attention in the literature.

Case Reports We report two male patient cases who presented with leukocytosis, elevated C-reactive protein, and a suspicious retroperitoneal mass of unknown origin on computed tomography. One patient also reported left lower quadrant pain, whereas the other patient suffered from back pain and weight loss. In both patients, idiopathic RPF was successfully diagnosed by using transduodenal EUS-FNA/FNB with 22- and 20-gauge aspiration needles. Histopathology revealed dense lymphocytic infiltrates and fibrosis. The procedures lasted approximately 25 and 20 minutes, respectively, and in both patients no serious adverse events occurred. Treatment included steroid therapy and administration of Azathioprine.

Conclusion We demonstrate that using EUS-FNA/FNB to diagnose RPF is a feasible, fast, and safe method, which should always be considered as a first-line diagnostic modality. Hence, this case report emphasizes that gastrointestinal endoscopists are likely to play an important role in the setting of suspected RPF.

Zusammenfassung

Hintergrund Die Retroperitonealfibrose, bei unbekannter Genese auch Morbus Ormond genannt, ist eine seltene Erkrankung, welche durch das Auftreten entzündlicher paraaortaler Infiltrate und Fibrose im Retroperitonealraum gekennzeichnet ist. Zur definitiven Diagnose bedarf es einer Biopsie der verdächtigen Läsion sowie der anschließenden histopathologischen Untersuchung. Zu den allgemein akzeptierten Methoden für die retroperitoneale Gewebeentnahme zählen die offene, laparoskopische sowie die CT-gesteuerte Biopsie. Die endosonografische Feinnadelpunktion von transduodenal hat in diesem Zusammenhang jedoch bislang überraschend wenig Aufmerksamkeit erregt.

Kasuistiken Wir berichten von 2 männlichen Patienten, die sich mit Leukozytose, erhöhtem C-reaktiven Protein und einer auffälligen retroperitonealen Strukturvermehrung unbekannten Ursprungs in der Computertomografie vorstellten. Ein Patient berichtete von Schmerzen im linken unteren Abdomen, während der andere unter Rückenschmerzen und Gewichtsverlust litt. Bei beiden Patienten konnte ein Morbus Ormond mittels der transduodenalen endosonografischen Feinnadelpunktion unter Verwendung von 22- und 20-Gauge-Aspirationsnadeln diagnostiziert werden. Das Verfahren dauerte jeweils etwa 25 beziehungsweise 20 Minuten und bei beiden Patienten traten keine unerwünschten Komplikationen auf. Zur Behandlung wurden Prednisolon und Azathioprin erfolgreich eingesetzt.

Schlussfolgerung Die Verwendung der transduodenalen endosonografischen Feinnadelpunktion zur Diagnose der Retroperitonealfibrose ist eine praktikable, schnelle und sichere Modalität, die in solchen Fällen immer als Mittel der ersten Wahl in Betracht gezogen werden sollte.

Keywords

Endoscopic Ultrasound-Guided Fine Needle Aspiration - Retroperitoneal Fibrosis - Retroperitoneal Space - Ormond's Disease - EUS - Biopsy - diagnostic imaging

Schlüsselwörter

Endosonografische Feinnadelpunktion - Retroperitonealfibrose - Retroperitonealraum - EUS - Morbus Ormond - Biopsie - Bildgebende Diagnostik

Publication History

Received: 23 November 2022

Accepted after revision: 21 December 2022

Article published online:
27 March 2023

• References

• 1 Tanaka T, Masumori N. Current approach to diagnosis and management of retroperitoneal fibrosis. Int J Urol 2020; 27: 387-394
• 2 Rivas J, Quintana L, Alvarez-Maestro M. et al. Retroperitoneal fibrosis: A literature review. Archivos espanoles de urologia 2020; 73: 60-67
• 3 Cronin CG, Lohan DG, Blake MA. et al. Retroperitoneal fibrosis: a review of clinical features and imaging findings. AJR Am J Roentgenol 2008; 191: 423-431
• 4 Vaglio A, Maritati F. Idiopathic Retroperitoneal Fibrosis. J Am Soc Nephrol 2016; 27: 1880-1889
• 5 Koike Y, Matsui S, Takase K. et al. CT-Guided Percutaneous Needle Biopsy in Patients with Suspected Retroperitoneal Fibrosis: A Retrospective Cohort Study. Cardiovasc Intervent Radiol 2019; 42: 1434-1440
• 6 Jenssen C, Hocke M, Fusaroli P. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV – EUS-guided Interventions: General aspects and EUS-guided sampling (Long Version). Ultraschall Med 2016; 37: E33-76
• 7 Polkowski M, Jenssen C, Kaye P. et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline – March 2017. Endoscopy 2017; 49: 989-1006
• 8 Fairweather J, Jawad A. Ormond disease: an old disease with a new name. Grand Rounds 2014; 14: L1-L3
• 9 Vaglio A, Salvarani C, Buzio C. Retroperitoneal fibrosis. Lancet 2006; 367: 241-251
• 10 van Bommel EFH, Jansen I, Hendriksz TR. et al. Idiopathic retroperitoneal fibrosis: prospective evaluation of incidence and clinicoradiologic presentation. Medicine (Baltimore) 2009; 88: 193-201
• 11 Li KP, Zhu J, Zhang JL. et al. Idiopathic retroperitoneal fibrosis (RPF): Clinical features of 61 cases and literature review. Clinical rheumatology 2010; 30: 601-605
• 12 Caiafa R, Sierra Vinuesa A, Salvador Izquierdo R. et al. Retroperitoneal Fibrosis: Role of Imaging in Diagnosis and Follow-up. Radiographics 2013; 33: 535-552
• 13 Corradi D, Maestri R, Palmisano A. et al. Idiopathic retroperitoneal fibrosis: Clinicopathologic features and differential diagnosis. Kidney international 2007; 72: 742-753
• 14 Kermani T, Crowson C, Achenbach S. et al. Idiopathic Retroperitoneal Fibrosis: A Retrospective Review of Clinical Presentation, Treatment, and Outcomes. Mayo Clinic proceedings Mayo Clinic 2011; 86: 297-303
• 15 Giannese D, Moriconi D, Cupisti A. et al. Idiopathic Retroperitoneal Fibrosis: What Is the Optimal Clinical Approach for Long-Term Preservation of Renal Function?. Urol Int 2022; 1-14
• 16 Brandt A, Kamper L, Kukuk S. et al. Associated Findings and Complications of Retroperitoneal Fibrosis in 204 Patients: Results of a Urological Registry. The Journal of urology 2011; 185: 526-531
• 17 Chira R, Dragomir I, Ichim V. et al. Transduodenal EUS FNA Diagnosis of Idiopathic Retroperitoneal Fibrosis. Journal of Gastrointestinal and Liver Diseases 2019; 28: 382-382
• 18 Kawakami Y, Takada Y, Ishigami K. et al. Idiopathic retroperitoneal fibrosis diagnosed by endoscopic ultrasonography-guided fine-needle biopsy. JGH Open 2021; 5: 151-152
• 19 Mita N, Iwashita T, Senju A. et al. Endoscopic ultrasound-guided fine-needle aspiration of pelvic lesions via the upper and lower gastrointestinal tract approaches. BMC Gastroenterology 2021; 21: 18
• 20 Song TJ, Kim JH, Lee SS. et al. The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses. Am J Gastroenterol 2010; 105: 1739-1745
• 21 Iglesias-Garcia J, Poley JW, Larghi A. et al. Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc 2011; 73: 1189-1196
• 22 Chen SJ, Qin L, Xie YJ. et al. Ultrasonography for Preoperative Diagnosis of Retroperitoneal Fibrosis. Ultrasound Q 2017; 33: 162-166
• 23 Mizuide M, Ryozawa S, Fujita A. et al. Complications of Endoscopic Ultrasound-Guided Fine Needle Aspiration: A Narrative Review. Diagnostics (Basel) 2020; 10