Cell and tissue biology · 2022
Lymphopenia and Mechanisms of T-Cell Regeneration.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Ma Lin, Zeng Jiping, Guo Qing, Liang Xiuming, Shen Li, Li Shuyan, Sun Yundong, Li Wenjuan, Liu Shili, Yu Han, Chen Chunyan, Jia Jihui
Аннотация
BACKGROUND: Gastrointestinal subepithelial lesions (SELs) arising from the muscularis propria pose diagnostic challenges, particularly paucicellular tumours such as leiomyomas, which frequently yield insufficient tissue on endoscopic ultrasound -guided fine-needle biopsy (EUS-FNB). Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) achieves superior diagnostic yield over conventional needle aspiration by obtaining intact tissue cores that preserve histologic architecture. Transoesophageal cryobiopsy has been reported for mediastinal lymph node sampling but has not been applied to gastrointestinal wall lesions.
CASE REPORT: A 50-year-old man presented with a progressively enlarging gastroesophageal junction mass originating from the muscularis propria (70 × 52 mm). Two EUS-FNB sessions (eight total passes with 19-, 22-, and 25-gauge needles) yielded only scant paucicellular smooth muscle fragments insufficient for definitive diagnosis. Positron emission tomography/computed tomography scan demonstrated fluorodeoxyglucose avidity (SUVmax 6.6), raising concern for malignancy. After the patient declined surgical excision and mucosal incision-assisted biopsy referral, transoesophageal cryobiopsy was performed using an EBUS bronchoscope with a 1.1 mm CO2 cryoprobe advanced through the oesophageal wall under ultrasound and fluoroscopic guidance. Cryobiopsy yielded tissue fragments up to 0.4 cm with preserved architecture. Immunohistochemistry confirmed leiomyoma (SMM+, desmin+, DOG1-, c-kit-, S100-, CD34-), excluding gastrointestinal stromal tumour. The patient developed a post-procedural sterile inflammatory response (C-reactive protein 188.2 mg/l) requiring 3-day hospitalization; imaging excluded perforation. He remains asymptomatic at 3-month follow-up.
CONCLUSION: Transoesophageal EBUS-guided cryobiopsy can provide diagnostic tissue from gastric subepithelial lesions refractory to standard EUS-FNB. However, the significant inflammatory response underscores the need for systematic safety evaluation, beginning with animal model studies, before broader clinical application.
LEARNING POINTS: Transoesophageal endobronchial ultrasound-guided cryobiopsy can yield architecturally preserved tissue sufficient for comprehensive immunohistochemical characterization of paucicellular gastric subepithelial lesions when standard endoscopic ultrasound-guided fine-needle biopsy fails.The significant post-procedural inflammatory response observed in this case highlights that the safety profile of transmural cryobiopsy at the gastrointestinal wall remains uncharacterized and requires systematic evaluation before broader application.Multidisciplinary collaboration between interventional pulmonology and gastroenterology is essential when adapting bronchoscopic techniques to gastrointestinal indications.
CASE REPORT: A 50-year-old man presented with a progressively enlarging gastroesophageal junction mass originating from the muscularis propria (70 × 52 mm). Two EUS-FNB sessions (eight total passes with 19-, 22-, and 25-gauge needles) yielded only scant paucicellular smooth muscle fragments insufficient for definitive diagnosis. Positron emission tomography/computed tomography scan demonstrated fluorodeoxyglucose avidity (SUVmax 6.6), raising concern for malignancy. After the patient declined surgical excision and mucosal incision-assisted biopsy referral, transoesophageal cryobiopsy was performed using an EBUS bronchoscope with a 1.1 mm CO2 cryoprobe advanced through the oesophageal wall under ultrasound and fluoroscopic guidance. Cryobiopsy yielded tissue fragments up to 0.4 cm with preserved architecture. Immunohistochemistry confirmed leiomyoma (SMM+, desmin+, DOG1-, c-kit-, S100-, CD34-), excluding gastrointestinal stromal tumour. The patient developed a post-procedural sterile inflammatory response (C-reactive protein 188.2 mg/l) requiring 3-day hospitalization; imaging excluded perforation. He remains asymptomatic at 3-month follow-up.
CONCLUSION: Transoesophageal EBUS-guided cryobiopsy can provide diagnostic tissue from gastric subepithelial lesions refractory to standard EUS-FNB. However, the significant inflammatory response underscores the need for systematic safety evaluation, beginning with animal model studies, before broader clinical application.
LEARNING POINTS: Transoesophageal endobronchial ultrasound-guided cryobiopsy can yield architecturally preserved tissue sufficient for comprehensive immunohistochemical characterization of paucicellular gastric subepithelial lesions when standard endoscopic ultrasound-guided fine-needle biopsy fails.The significant post-procedural inflammatory response observed in this case highlights that the safety profile of transmural cryobiopsy at the gastrointestinal wall remains uncharacterized and requires systematic evaluation before broader application.Multidisciplinary collaboration between interventional pulmonology and gastroenterology is essential when adapting bronchoscopic techniques to gastrointestinal indications.