Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2021; 27(13): 1354-1361
Published online Apr 7, 2021. doi: 10.3748/wjg.v27.i13.1354
Transperineal core-needle biopsy of a rectal subepithelial lesion guided by endorectal ultrasound after contrast-enhanced ultrasound: A case report
Qiong Zhang, Jie-Ying Zhao, Hua Zhuang, Chun-Yan Lu, Jin Yao, Yuan Luo, Yong-Yang Yu
Qiong Zhang, Jie-Ying Zhao, Hua Zhuang, Yuan Luo, Department of Diagnostic Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Chun-Yan Lu, Jin Yao, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Yong-Yang Yu, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhang Q was responsible for the conceptualization, data curation, investigation, and original manuscript drafting; Zhao JY was responsible for data curation and original manuscript drafting; Zhuang H was responsible for the conceptualization, data curation, funding acquisition, supervision, and manuscript drafting and review; Lu CY, Yao J, Luo Y, and Yu YY were responsible for data curation; all authors issued final approval for the version to be submitted.
Supported by National Natural Science Foundation of China, No. 81101061; and Sichuan Science and Technology Planning Project, China, No. 2017JY0074.
Informed consent statement: Informed written consent was obtained from the patient for the publication of the relevant information.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua Zhuang, MD, PhD, Associate Professor, Director, Department of Diagnostic Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Wuhou District, Chengdu 610041, Sichuan Province, China. annzhuang@yeah.net
Received: November 3, 2020
Peer-review started: November 3, 2020
First decision: January 23, 2021
Revised: January 29, 2021
Accepted: March 1, 2021
Article in press: March 1, 2021
Published online: April 7, 2021
Abstract
BACKGROUND

Rectal subepithelial lesions (SELs) are commonly seen in endoscopic examination, generally manifested as bumps with a smooth surface. Precise preoperative diagnoses for rectal SELs are difficult because abnormal tissues are not easily to be obtained by regular endoscopic forceps biopsy. Traditional guidance modalities of preoperative biopsy, including endoscopic ultrasound, computed tomography, and transabdominal ultrasound, are often unsatisfactory. An updated, safe, and effective biopsy guidance method is required. We herein report a new biopsy guidance modality—endorectal ultrasound (ERUS) combined with contrast-enhanced ultrasound (CEUS).

CASE SUMMARY

A 32-year-old woman complained of a mass inside the rectovaginal space for 9 years, which became enlarged within 1 year. A rectal SEL detected by endoscopy was suspected to be a gastrointestinal stromal tumor or exophytic uterine fibroid. Pathological diagnosis was difficult because of unsuccessful transabdominal core needle biopsy with insufficient tissues, as well as vaginal hemorrhage. A second biopsy was suggested after multiple disciplinary treatment discussion, which referred to a transperineal core needle biopsy (CNB) guided by ERUS combined with CEUS. Adequate samples were procured and rectal gastrointestinal stromal tumor was proved to be the pathological diagnosis. Imatinib was recommended for first-line therapy by multiple disciplinary treatment discussion. After the tumor shrunk, resection of the rectal gastrointestinal stromal tumor was performed through the posterior vaginal wall. Adjuvant therapy was applied and no recurrence or metastasis has been found by the last follow-up on December 13, 2019.

CONCLUSION

Transperineal CNB guided by ERUS and CEUS is a safe and effective preoperative biopsy of rectal SELs yet with some limitations.

Keywords: Transperineal core needle biopsy, Endorectal ultrasound, Contrast-enhanced ultrasound, Rectal subepithelial lesion, Case report

Core Tip: Rectal subepithelial lesions (SELs) often manifest as bumps with a smooth surface on endoscopy. An efficient biopsy strategy is crucial to sampling for differentiation of pathological types. The transperineal core needle biopsy guided by endorectal ultrasound combined with contrast-enhanced ultrasound overcomes the limitations of previous guidance, such as sampling inadequacy, high risk of complications, and exposure to radiation. In our case, unsuccessful transabdominal biopsy led to failure of pathological diagnosis. The patient underwent this new biopsy modality then, and a diagnosis was finally made. No complications occurred. We recommend this new strategy as a promising tool for rectal SEL biopsy.