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Case Reports
. 2012:9:24.
doi: 10.4103/1742-6413.103025. Epub 2012 Oct 31.

Endoscopic ultrasound-guided fine needle aspiration of the celiac ganglion: A diagnostic pitfall

Di Xia  1 , Kidada N Gilbert-Lewis, Manoop S Bhutani, Ranjana S Nawgiri
Affiliations
Case Reports

Endoscopic ultrasound-guided fine needle aspiration of the celiac ganglion: A diagnostic pitfall

Di Xia et al. Cytojournal. 2012.

Abstract

Endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) is now widely used as a primary tool in the evaluation of lymphadenopathy in both the mediastinum and abdomen. A sympathetic ganglion may be mistaken for an enlarged lymph node on endoscopic ultrasound and are rarely sampled as such. A 51-year-old female presented with a history of weight loss, vomiting for several months, and right upper quadrant discomfort. Computed tomography (CT) and magnetic resonance imaging (MRI) scans showed a dilated common bile duct (CBD) with a possible periampullary mass, paraaortic, and pericelial lymph nodes suspicious for metastatic disease. Endosonography revealed a 17 mm oval hypoechoic structure with distinct margins in the para-aortic, celiac axis region suggestive of an enlarged lymph node. An EUS-FNA was done. Cytology revealed ganglion cells with large oval epithelial-like cells with round nuclei and prominent nucleoli consistent with a benign sympathetic ganglion. It is crucial for the cytopathologist to be aware of the fact that the endoscopist might have sampled a celiac ganglion instead of a celiac lymph node and be able to distinguish the cytological features of a benign sympathetic ganglion from a malignant process.

Keywords: Celiac ganglion; endoscopic ultrasound; fine needle aspiration.

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Figures

Figure 1
Figure 1
EUS-Guided FNA of celiac ganglion, diff-quik (40×): Shows many ganglion cells with intervening stroma
Figure 2
Figure 2
EUS-Guided FNA of celiac ganglion, pap. (40×): Shows numerous large ganglion cells occurring in association with a spindled stroma
See this image and copyright information in PMC

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