A 59 year old male with a history of T3, N1 esophageal adenocarcinoma underwent neoadjuvant radiation and chemotherapy followed by an esophagectomy and gastric pull-up procedure. Two years later a routine follow-up CT scan of the abdomen revealed a lesion in the liver. He was referred for EUS. EGD revealed normal post-surgical anatomy. EUS identified a 2 cm, hypoechoic mass in the left lobe of the liver. EUS-guided FNA was performed with a 25 gauge needle using a transgastric approach. Cytology revealed pleomorphic clusters of malignant epithelial cells characterized by nuclear enlargement, overlapping nuclei with a high nuclear to cytoplasmic ratio and cytoplasmic vacuoles consistent with metastatic adenocarcinoma.
Harry Aslanian, M.D., Yale University