A 60-year-old male with a 20 pack year smoking history and diabetes mellitus type 2, with no known asbestos exposure, underwent a chest and abdominal X-ray due to chest and abdominal pain complain which was significant for bilateral pleural effusions. Chest computed tomography (CT) revealed multiple bilateral pleural masses and mediastinal lymphadenopathy (Fig. 1A1B).
A pleurocentesis and close pleural biopsy was performed but the results were non-diagnostic.
An EBUS-TBNA and EUS-B-FNA was therefore performed using a conventional C-EBUS (Olympus). Under EBUS guidance, a pleural mass adjacent to the lower segment of the esophagus was identified (Fig. 2). EUS-B-FNA was performed of the pleural mass using a 21-gauge needle. Subsequently, mediastinal lymph nodes 4R and 7 were sampled with C-EBUS-TBNA with no immediate complication and no ultrasonographic signs of vascular damage. The patient was observed for one hour in the recovery room then for the following 12 hours without evidence of complications.
The specimens were examined cytologically, histologically and immunohistochemically (Fig. 3). The morphologic and immunostaining findings were consistent with clear cell carcinoma.