Ileum Tumor Diagnosed by an Endoscopic Ultrasound-fine-needle Biopsy Using a Forward-viewing Echoendoscope.

An 80-year-old man presented with a chief complaint of abdominal pain. Computed tomography showed a 65-mm mass in the terminal ileum (Picture A); therefore, colonoscopy was performed. An elevated sub-epithelial lesion was found in the cecum (Picture B). Moving into the terminal ileum proved difficult due to the narrow lumen. A forward-viewing (FV) echoendoscope (TGF-UC260J, Olympus Medical Systems, Tokyo, Japan) was inserted into the cecum for an endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). EUS showed a heterogeneous, hypoechoic mass with clear margins; an FNB (22 G Acquire, Boston Scientific, Natick, USA) was performed via the cecum (Picture C). Immunohistochemically, a diffuse cluster of differentiated CD20 expression was distinctly identified in neoplastic cells, resulting in a diagnosis of diffuse large B-cell lymphoma (Picture D). We were able to successfully insert the endoscope into the cecum and diagnose an ileal tumor using not conventional EUS but an FV-echoendoscope (1,2). Furthermore, this resulted in appropriate treatment without requiring laparotomy.

Picture.

The authors state that they have no Conflict of Interest (COI).