Positron Emission Tomography-Negative Mediastinal Lymph Node Metastasis From Clear Cell Renal Cell Carcinoma 11 Years...

A 73-year-old man was referred for evaluation of mediastinal lymphadenopathy. He had undergone right nephrectomy for clear cell renal cell carcinoma (ccRCC; pT3aN0M0, stage III) 11 years earlier and had remained recurrence-free without adjuvant therapy. Positron emission tomography/computed tomography (PET/CT) revealed an enlarged subcarinal lymph node which was non-FDG avid. Bronchoscopy was performed to obtain a pathological diagnosis. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) initially yielded bloody and inadequate specimens on rapid on-site cytologic evaluation (ROSE). The sampling technique was therefore switched to endobronchial ultrasound-guided transbronchial needle capillary sampling (EBUS-TBNCS), and ROSE demonstrated adequate cellular material with atypical cells. Histopathology and immunohistochemistry confirmed metastatic ccRCC. This case highlights that metastatic ccRCC should be considered in PET-negative mediastinal lymphadenopathy more than a decade after nephrectomy and that EBUS-TBNCS may facilitate diagnostic tissue acquisition when conventional EBUS-TBNA yields bloody specimens.