Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2023; 29(7): 1235-1242
Published online Feb 21, 2023. doi: 10.3748/wjg.v29.i7.1235
Percutaneous transhepatic intraportal biopsy using gastroscope biopsy forceps for diagnosis of a pancreatic neuroendocrine neoplasm: A case report
Guang-Chuan Wang, Guang-Jun Huang, Chun-Qing Zhang, Qian Ding
Guang-Chuan Wang, Guang-Jun Huang, Chun-Qing Zhang, Qian Ding, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Author contributions: Wang GC drafted the manuscript and collected data; Huang GJ performed the operation; Zhang CQ guided the operation; Ding Q guided the operation and revised the manuscript; all authors have approved the final draft submitted.
Supported by the National Natural Science Foundation of China, No. 82000566; Natural Science Foundation of Shandong Province, No. ZR2020QH036 and No. ZR2022MH010.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qian Ding, MD, Chief Physician, Doctor, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan 250021, Shandong Province, China. dq224@163.com
Received: November 8, 2022
Peer-review started: November 8, 2022
First decision: January 3, 2023
Revised: January 19, 2023
Accepted: January 30, 2023
Article in press: January 30, 2023
Published online: February 21, 2023
Processing time: 104 Days and 14.2 Hours
Abstract
BACKGROUND

Pancreatic neuroendocrine neoplasms (PNENs) are a rare group of neoplasms originating from the islets of the Langerhans. Portal vein tumor thrombosis has been reported in 33% of patients with PNENs. While the histopathological diagnosis of PNENs is usually based on percutaneous biopsy or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), these approaches may be impeded by gastric varices, poor access windows, or anatomically contiguous critical structures. Obtaining a pathological diagnosis using a gastroscope biopsy forceps via percutaneous transhepatic intravascular pathway is an innovative method that has rarely been reported.

CASE SUMMARY

A 72-year-old man was referred to our hospital for abdominal pain and melena. Abdominal contrast-enhanced magnetic resonance imaging revealed a well-enhanced tumor (size: 2.4 cm × 1.2 cm × 1.2 cm) in the pancreatic tail with portal vein invasion. Traditional pathological diagnosis via EUS-FNA was not possible because of diffuse gastric varices. We performed a percutaneous transportal biopsy of the portal vein tumor thrombus using a gastroscope biopsy forceps. Histopathologic examination revealed a pancreatic neuroendocrine neoplasm (G2) with somatostatin receptors 2 (+), allowing systemic treatment.

CONCLUSION

Intravascular biopsy using gastroscope biopsy forceps appears to be a safe and effective method for obtaining a histopathological diagnosis. Although well-designed clinic trials are required to obtain more definitive evidence, this procedure may help improve the diagnosis of portal vein thrombosis and related diseases.

Keywords: Percutaneous transhepatic intravascular biopsy; Portal vein tumor thrombosis; Gastroscope biopsy forceps; Pancreatic neuroendocrine neoplasms; Case report

Core Tip: Endoscopic ultrasound-guided fine-needle aspiration or percutaneous biopsy of pancreatic neuroendocrine neoplasms patients can be impeded by gastric varices and poor access windows. In this patient, we faced the challenge of obtaining biopsy of the pancreatic mass which had invaded the portal vein. We performed a percutaneous transportal biopsy of the portal vein tumor thrombosis using a gastroscope biopsy forceps. Our experience suggests that gastroscope biopsy forceps is a viable alternative to obtain biopsy in the portal vein system. Our work expands the use of diagnostic transhepatic portal catheterization. This method may also help prevent repeated liver puncture, reducing the risk of complications.