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

EUSJ_240073
10.1097/eus.0000000000000074
00008
3
Images and Videos
A rare but interesting case of small intestinal tumor diagnosed by transrectal EUS-FNA (with video)
https://orcid.org/0000-0002-7093-9596
Wang Shuyue szwangshuyue@163.com

Cheng Guilian ∗
Hu Duanmin huduanmin@163.com

Department of Gastroenterology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
∗ Address for correspondence: Department of Gastroenterology, Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu Province, China. E-mail: zixicheng@aliyun.com (G. Cheng).
Jul-Aug 2024
16 8 2024
13 4 269270
03 12 2023
27 5 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 46-year-old woman was admitted to the gastroenterology department with 6 months of intermittent abdominal distension. The enhanced CT of the abdomen revealed multiple soft tissue masses in the small intestine with slight enhancement in arterial phase, accompanied by multiple enlarged retroperitoneal lymph nodes and extensive thickening of the mesentery [Figure 1]. Double balloon enteroscopy showed multiple submucosal lesions of varying sizes with depressions and erosions on the surface [Figure 2], and biopsy indicated chronic inflammation.

Figure 1 Abdominal contrast-enhanced CT shows multiple soft tissue density lesions in the small intestine.

Figure 2 Endoscopic image of the submucosal lesions in the small intestine.

Because malignant tumors could not be ruled out, transrectal EUS-FNA was performed. EUS revealed multiple space-occupying lesions in the small intestine, moving with intestinal peristalsis. The peristalsis was weakened after intramuscular injection of 10 mg raceanisodamine hydrochloride, and then EUS-guided fine-needle aspiration was performed [Figure 3; Video 1]. Biopsies showed no significant pathological mitotic figure. Immunohistochemistry revealed that S-100 [Figure 4] was positive, whereas c-kit, SMA, CD34, DOG-1, and Calretinin were negative. Finally, the pathological diagnosis was neurofibroma.

Figure 3 Endoscopic ultrasonography-guided fine-needle tissue acquisition from the detected submucosal lesions.

Figure 4 Immunohistochemistry revealed that S-100 was positive.

Because the tumor range is too large, accompanied by multiple enlarged lymph nodes, it cannot be completely removed. Therefore, the patient received symptomatic treatment. After the symptoms improved, she chose to continue follow-up due to concerns about the risk of surgery. In this very rare case of multiple neurofibromas of the small intestine, EUS-FNA plays a key role in achieving the pathological diagnosis. As we know, this is the first report of small intestinal neurofibroma confirmed by transrectal EUS-FNA. Meanwhile, clinicians need to be aware that neurofibroma is a differential diagnosis of multiple tumors of the small intestine.

Declaration of Patient Consent

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

Source of Funding

This study was supported by the Project of State Key Laboratory of Radiation Medicine and Protection, Soochow University (GZK12023010).

Conflicts of Interest

The authors disclose no conflicts.

Author Contributions

All authors were involved in writing all sections of the case.

Published online: 16 August 2024
