Five Cases of Hepatic Mesenchymal Tumors Diagnosed by Endoscopic Ultrasound-Guided Tissue Acquisition

Percutaneous biopsy remains the gold standard for diagnosing focal liver lesions; however, endoscopic ultrasound-guided tissue acquisition (EUS-TA) has recently emerged as a promising alternative. Although its diagnostic performance is favorable, most available evidence has focused on epithelial tumors, and reports on mesenchymal tumors are rare. Herein, we report five cases of hepatic mesenchymal tumors diagnosed using EUS-TA. The cohort comprised four male and one female patient, with a median age of 70 years (range, 63-88). The median targeted lesion size was 30 mm (range, 22-61 mm), predominantly located in the left lateral hepatic segments. Four cases underwent transgastric biopsy and one transduodenal biopsy, using either a 22-gauge aspiration or biopsy needle. All procedures were technically successful, and no procedure-related adverse events occurred. Histopathological examination established definitive diagnoses of leiomyosarcoma (n = 2), angiosarcoma (n = 1), epithelioid hemangioendothelioma (n = 1), and metastatic gastrointestinal stromal tumor (n = 1). Subsequent management included chemotherapy in three patients and best supportive care in two. This case series demonstrates that EUS-TA is a feasible diagnostic modality for hepatic mesenchymal tumors, providing sufficient tissue for histological and immunohistochemical evaluation.