VideoGIE | 2019
Transoral EUS-guided FNA of prevertebral cervical metastasis
Abstract
Figure 2. Endoscopic image of ill-defined, indurated mass protruding into oropharynx. A 73-year-old man with a history of 2 episodes of squamous cell lung cancer treated with resection, chemotherapy, and radiation, along with stage pT1bN0 esophageal adenocarcinoma treated with esophagectomy, presented to our hospital with 2 weeks of worsening cervical neck pain and dysphagia. A CT scan demonstrated a new 2.7-cm prevertebral rim-enhancing lesion in the oropharynx at C2 (Fig. 1A and B). Given the patient’s history of multiple prior cancers, the ear, nose, and throat service was consulted to sample the lesion. However, their approach would require an open surgical biopsy, which, given the patient’s odynophagia, might worsen pain and impair healing. Accordingly, the interventional radiology service was next consulted to consider biopsy under CT guidance; however, they considered the location of the mass difficult to access. At this point, the patient was referred to the gastroenterology service for consideration of EUS-guided FNA (EUS-FNA) (Video 1, available online at www.VideoGIE.org). General anesthesia was used to control the airway, and a curved linear array echoendoscope (GF-UCT160, Olympus, Center Valley, Pa, USA) was advanced into the posterior oropharynx. At this point, a firm indurated ill-defined masslike protrusion was noted in the oropharynx (Fig. 2).