PMC9393813_01
a CT image showing the subcarinal mediastinal lesion (red arrow). b EBUS-TBNA biopsy (TBNA needle sheath, red arrow; TBNA needle stylet, green arrow) of the mediastinal lesion. c Penetration of the cryoprobe (green arrow) through TBNA needle sheath (red arrow) into the target lesion under real-time visualization. d Sample (red arrow) obtained from non-cautery assisted transbronchial mediastinal cryobiopsy.
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F1
A chest contrast-enhanced CT revealed mediastinal and bilateral hilar lymphadenopathies with slight and heterogeneous enhancement during the arterial phase, bilateral pleural effusion, and left inferior pulmonary inflammation (Fig. 1a). TBNA with a 21-gauge needle (Biostar-S217, Broncus, China) (Fig. 1b), we advanced its sheath along with the needle stylet into the lesion, which was visualized with the EBUS scope. Thereafter, we pulled out the stylet of the TBNA needle, leaving the sheath in the target lesion that served as a working cannula for cryobiopsy (Fig. 1c). The cryoprobe was then advanced into the target lesion via the needle sheath under the real-time supervision (Fig. 1c). After cooling down to -60 C for 7 s, the cryoprobe tip attached with the rapidly frozen material was extracted from the biopsy site (Fig. 1d).
a H&E staining of the specimen from EBUS-TBNA. b H&E staining of the specimen from non-cautery assisted transbronchial mediastinal cryobiopsy. c Immunohistochemistry staining of the specimen from non-cautery assisted transbronchial mediastinal cryobiopsy. Scale bars = 30 mum. EBUS-TBNA, endobronchial ultrasound-guided transbronchial needle aspiration.
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F2
TBNA samples showed squeezed and deformed atypical cells (Fig. 2a). The specimens from cryobiopsy suggested a diagnosis of non-Hodgkin's lymphoma (Fig. 2b). Immunohistochemistry staining indicated CD20(+), CD79alpha(+), CD3(+), CD43(+), BCL-2(+), BCL-6(+), CD10(-), MUM1(+), Cyclin D1(-), Ki-67(+), CK(-), and EBER(-), confirming diffuse large B-cell lymphoma (Fig. 2c).