
==== Front
Endosc Ultrasound
Endosc Ultrasound
EUSJ
Endoscopic Ultrasound
2303-9027
2226-7190
Lippincott Williams & Wilkins

EUSJ_240069
10.1097/eus.0000000000000068
00010
3
Images and Videos
EUS-FNA to diagnose a submucosal oropharyngeal carcinoma
Zhang Zhenming zhangzhenming85@126.com
1
Luo Yao luoyao@scszlyy.org.cn
1
Shi Min shimin@scszlyy.org.cn
2
Li Shengping lishengping@scszlyy.org.cn
1
Bao Yu 1 ∗
1 Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuang Province, China
2 Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China.
∗ Address for correspondence: Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, No. 55, Section 4, Renmin South Road, Wuhou District, Chengdu 610041, Sichuan Province, China. E-mail: baoyu514@163.com (Y. Bao).
Jul-Aug 2024
16 8 2024
13 4 273275
10 1 2024
18 4 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc on behalf of Scholar Media Publishing.
2024
Wolters Kluwer on behalf of Scholar Media Publishing.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcA 59-year-old man was referred to our hospital after noticing a mass on the right side of his neck for 1 month. Fine-needle aspiration of the cervical lesion yielded pathological findings consistent with metastatic squamous cell carcinoma. Magnetic resonance imaging revealed the presence of an irregular soft tissue lesion measuring 3.5 cm × 2.1 cm within the right oropharyngeal wall, displaying enhancement on T1-weighted contrast-enhanced imaging [Figure 1]. Laryngoscopy identified a slight elevation on the right side of the soft palate; however, the surface was smooth [Figure 2], and no significant abnormalities were observed during the narrowband imaging assessment.

Figure 1 Magnetic resonance imaging scan of the 59-year-old patient revealed the presence of a soft tissue mass within the right oropharyngeal wall. The tumor exhibited contrast enhancement, as shown in T1-weighted images.

Figure 2 No abnormalities were detected using white light endoscopy.

EUS-FNA was conducted under local anesthesia to confirm the diagnosis. A thorough examination of the submucosal oropharyngeal lesion was performed using an echoendoscope (BF-UC260FW; Olympus, Japan) inserted orally. EUS revealed an irregularly shaped mass in the right oropharyngeal wall, characterized by heterogeneous hypoechoic characteristics with a distinct boundary with surrounding structures. Under real-time Doppler ultrasound guidance, a 21-gauge needle (NA-201SX-4021; Olympus) was used to puncture the lesion [Figure 3]. A suction pressure of 5 mL was applied using a syringe. Subsequently, the acquired samples were sent for pathological examination [Figure 4]. Importantly, no adverse events were observed during or after the puncture procedure. Ultimately, the patient received a pathological diagnosis of oropharyngeal squamous cell carcinoma [Figure 5] and was given chemoradiotherapy.

Figure 3 EUS-FNA was performed using a 21-gauge aspiration needle.

Figure 4 Aspirated tissue specimens obtained using EUS-FNA.

Figure 5 The diagnosis was pathologically confirmed as a submucosal type of oropharyngeal squamous cell carcinoma (original magnification ×200).

Although oropharyngeal cancer is a relatively common malignancy in the head and neck region, the submucosal subtype is quite rare. Conventional endoscopic biopsy approaches are limited to sampling the mucosal layer within the lesion area, often resulting in an inability to reach a definitive diagnosis due to the inadequate depth of the biopsy.[1–3] In contrast, EUS-FNA is a safe, effective, and minimally invasive technique for obtaining deep tissue samples in patients suspected of having submucosal malignant lesions.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his names and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Source of Funding

None.

Conflicts of Interest

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Author Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Zhenming Zhang, Yao Luo, Min Shi, Shengping Li, and Yu Bao. The EUS-FNA procedure was performed by Zhenming Zhang and Yao Luo. The first draft of the manuscript was written by Zhenming Zhang and Yao Luo. All authors read and approved the final manuscript.

Published online: 16 August 2024

Zhenming Zhang and Yao Luo contributed equally to this work.
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References

1 Pfeiffer J Maier W Boedeker CC Ridder GJ . Transmucosal core needle biopsy: a novel diagnostic approach to oral and oropharyngeal lesions. J Oral Maxillofac Surg 2014;72 :1594–1600. doi:10.1016/j.joms.2014.02.022.24746396
2 Shah SB Singer MI Liberman E Ljung BM . Transmucosal fine-needle aspiration diagnosis of intraoral and intrapharyngeal lesions. Laryngoscope 1999;109 :1232–1237. doi:10.1097/00005537-199908000-00009.10443825
3 Zhang ZM Zhou LX Bao Y , . Clinical application of endonasopharyngeal ultrasound–guided transnasopharyngeal needle aspiration in the diagnosis of submucosal nasopharyngeal carcinoma. Endosc Ultrasound 2020;9 :397–401. doi:10.4103/eus.eus_19_20.32655081
