Endoscopic Ultrasound -guided Fine-Needle Aspiration of a Portal Vein Thrombus to Aid in the Diagnosis and Staging of Hepatocellular Carcinoma.

The most common primary tumor of the liver is hepatocellular carcinoma (HCC), also known as hepatoma.1 There are several risk factors for developing hepatoma, such as chronic hepatitis B and C virus infection, cirrhosis, and carcinogens (ie, aflatoxin).2 The incidence of HCC, which is often a fatal disease, is on the rise in developed nations, including the United States. Over the past 3 decades, the incidence of HCC has not only increased, but has also shifted toward younger individuals.3 The stage of HCC at diagnosis is an important factor in overall treatment course and prognosis. Patients with early-stage disease can be offered possible curative surgical intervention, transplantation, or resection. In contrast, an advanced disease stage negates any surgical intervention, and only palliative treatment, such as chemotherapy or chemoembolization, can be offered to these patients. Therefore, every possible attempt should be made to accurately stage HCC. Fine-needle aspiration (FNA) of a portal vein thrombus (PVT), when present, is an effective procedure for diagnosing and staging HCC.4-9 Although percutaneous ultrasound (US)-guided FNA of a PVT has been well documented, we are only aware of 1 case report in the literature that has reported the use of endoscopic ultrasound (EUS)-guided FNA of a PVT to diagnose HCC.4-10 We report the second case of EUS-guided FNA of a PVT in a patient without any history of cirrhosis to successfully diagnose and stage HCC in the absence of a liver mass on abdominal computed tomography (CT) and US. Hazar Michael, MD1 Christopher Lenza, DO1 Mala Gupta, MD2 Douglas S. Katz, MD2 1University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey; 2Winthrop-University Hospital, Mineola, New York