Lymph node metastasis diagnosed by EUS-FNA in four cases with hepatocellular carcinoma

Hepatocellular carcinoma (HCC) rarely accompanies lymph node (LN) metastasis. As lymphadenopathy is observed in a variety of diseases, definitive diagnosis of metastasis of HCC is difficult without histological evidence. This report presented four cases of HCC associated with LN metastasis diagnosed using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and analyzed characteristics of CT image and histology of metastatic nodes. In current cases, metastatic nodes commonly demonstrated ill-enhanced masses with marginal enhancement on computed tomography (CT). Before FNA, nodal lymphoma or metastasis from the unknown origin tumor had been also suspected, but histology of the aspirated nodal tissues all demonstrated poorly differentiated HCC. No complication was recognized during and after FNA procedures. EUS-FNA is thought to be a safe and effective modality for obtaining histological evidence of lymphadenopathy in cases with HCC.