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Melanoma is an uncommon tumor and represents about 1.5% of all neoplasms. In the mediastinum, it presents as a primary neoplasm or metastasis. Diagnosis is essential for the adoption of the best therapy. Endosonography-guided fine needle aspiration (EUS-FNA) obtains cell samples and, when associated with other auxiliary exams such as immunohistochemistry, is useful to identify and differentiate primary and/or metastatic mediastinal lesions from a wide variety of other neoplasms. The endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) sensitivity is low and similar to endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNB) performed with the ProCore 25G or 22G needle. Thus, the diagnosis of this type of tumor becomes a great challenge. The authors report the first case in the literature of metastatic mediastinal melanoma derived from malignant cutaneous melanoma, which was submitted to Endosonography-guided fine needle biopsy (EUS-FNB) with the new ProCore 20G, to obtain tissue, being confirmed by histological examination of the specimens obtained with a single puncture.

Purpose Imaging diagnosis of SPN is difficult. Preoperative diagnosis by EUS-FNA) is possible, safe, and has been reported in the literature. However, its usefulness is still controversial. The aim of this study was to determine the accuracy of the EUS-FNA and imaging findings in CT and MRI/MRCP exams in the diagnosis of patients with SPN. Methods We retrospectively reviewed the medical records of patients undergoing EUS-FNA with suspected diagnosis of SPN on imaging studies in 5 high-volume hospitals. The final diagnosis was obtained after the histological examination of the surgical specimen. Demographic data, CT, MRI and EUS findings, anatomopathological specimen and McH results obtained by EUS were analyzed. Results Fifty-four patients were included, of which 49 (90.7%) were women with an average age of 33.4 (range 11–78) years. The most common symptom presented was abdominal pain, present in 35.2%. SPN was detected incidentally in 32 (59%). The mean size of the tumors was 3.8 cm (SD: 2.26). The most common findings at EUS were a solid, solid/cystic, and cystic lesion in 52.9%, 41.1% and 7.8%, respectively. The final diagnosis was SPN in 51 patients and NF-NET in 3. The correct diagnosis was made by CT, MRI, EUS and EUS-FNA in 21.9%, 28.9%, 64.7% and 88.2%, respectively. EUS-FNA associated with CT and MRI increased diagnostic performance to 94.11% and 94.11%, respectively. Conclusion Differential diagnosis between SPN and NF-NET with imaging tests can be difficult. EUS-FNA increases preoperative diagnosis in such cases and should be routinely used to rule out NF-NET.

Escalating an indication of EUS for diagnosis and treatment justifies the evaluation of the conditions associated with the adverse events (AE) and related deaths. The aim is to evaluate and compare the incidence of AE and deaths after diagnostic-EUS (D-EUS) and interventional-EUS (I-EUS).This retrospective study included patients undergoing D-EUS and I-EUS, in two centers for 28 years (03/1992 to 12/2019). Were noted parameters such as: age, gender, indication of EUS, modality, time of occurrence and severity of AE, type of treatment imposed and whether there was death. Descriptive analysis was performed using means, standard deviation and frequencies of the variables of interest.13,196 procedures performed, 9843 D-EUS and 3353 I-EUS. Thirty-seven (0.3%) had AE with six deaths (0.04%). The overall rate of AE for D-EUS and I-EUS was 0.08% and 0.86%, respectively (Despite the low incidence of AE and mortality after EUS, the occurrence of severe complications, especially perforation in D-EUS, may support the review of therapeutic protocols, aiming to ensure that a quality and safety process is implemented in the practice of EUS.