Small metastatic liver tumors diagnosed with endoscopic ultrasonography-guided fine needle aspiration

Currently, histopathological diagnosis of liver tumors is mainly obtained by percutaneous needle biopsy in Japan. We report a case of a small metastatic liver tumor diagnosed with endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) , in whom the lesions were located in unapproachable area by percutaneous needle biopsy. A 67-year-old woman with a previous history of sigmoid colon cancer and pancreatic neuroendocrine tumor was suspected to have metastatic liver tumors of ＜ 10 mm on computed abdominal tomography and magnetic resonance image. She had Chilaiditi’s syndrome and the tumors could not be visualized on external abdominal ultrasonography. Therefore, EUS-FNA was attempted to the lesion. EUS-FNA was successfully performed to the lesion in the right hepatic lobe and it was diagnosed with NET G2 from the histopathologically findings of the biopsied specimen. We believe that EUS-FNA is feasible and useful for liver tumors in cases that are difficult to visualize on external abdominal ultrasonography.