Laparoscopic lymph node biopsy for lymphoma with a novel use of indocyanine green fluorescence in a 66-year-old male patient

Marco Casaccia; Marco Mora; Gregorio Santori; Chiara Ghiggi; Emanuele Angelucci

doi:10.1016/j.ijscr.2021.106692

Laparoscopic lymph node biopsy for lymphoma with a novel use of indocyanine green fluorescence in a 66-year-old male patient

Int J Surg Case Rep. 2022 Jan:90:106692. doi: 10.1016/j.ijscr.2021.106692. Epub 2021 Dec 20.

Authors

Marco Casaccia¹, Marco Mora², Gregorio Santori³, Chiara Ghiggi⁴, Emanuele Angelucci⁴

Affiliations

¹ Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy. Electronic address: marco.casaccia@unige.it.
² Department of Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
³ Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
⁴ Hematology Unit and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.

Abstract

Introduction: Indocyanine green (ICG) near-infrared fluorescence is primarily employed in detecting Intraoperative sentinel lymph node (SLN) mapping or to evaluate the extent of radical lymphadenectomy mainly in colo-rectal and gastric cancer. To date there are no reports indicating the use of this dye to detect pathologic lymphatic tissue when a lymph node biopsy for suspected lymphoproliferative disease is performed.

Presentation of case: A 66-year-old male patient was admitted to the hospital for severe pain of left renal colic type. A computed tomography (CT) scan and a positron emission tomography (PET) showed a left hydroureteronephrosis due to ureter compression by paraortic solid tissue of lymphomatous aspect with a standardized uptake value (SUV) of 15. Multiple lymphadenopathies on paracaval, para-aortic and common iliac sites were present as well.

Discussion: A laparoscopic lymph node biopsy (LLB) was planned for diagnostic purposes. After induction of anesthesia a ICG solution was injected Intradermally at both inguinal regions. At laparoscopy a complete visualization of the pathologic lymphnodes was achieved, enabling incisional biopsies of the lymphomatous mass. Histopathological examination showed an extranodal localization of an aggressive B-cell non-Hodgkin lymphoma.

Conclusion: ICG-fluorescence seems to offer a simple and safe method for pathologic lymph node detection. LLB in the suspicion of intra abdominal lymphoma can largely take advantage by this novel opportunity not yet tested to date. More studies with large case series are needed to confirm the efficacy of ICG-fluorescence for detecting pathologic lymph nodes.

Keywords: Case report; Fluorescence; ICG; Indocyanine green; Laparoscopic biopsy; Laparoscopic surgery; Lymphoma.