Novel Insights from Clinical Practice

Kurian E.M.a· Abu-Hijleh M.b· Lowrey T.R.a· De Las Casas L.E.a

Author affiliations

aDepartment of Anatomic Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
bDepartment of Internal Medicine, Pulmonary Critical Care Medicine/Interventional Pulmonary, University of Texas Southwestern Medical Center, Dallas, TX, USA

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Article / Publication Details

First-Page Preview

Received: March 17, 2022
Accepted: April 18, 2022
Published online: July 27, 2022

Number of Print Pages: 4
Number of Figures: 1
Number of Tables: 0

ISSN: 0001-5547 (Print)
eISSN: 1938-2650 (Online)

For additional information: https://www.karger.com/ACY

Abstract

Introduction: In patients with a history of malignancy, follow-up surveillance of lymph nodes (LNs) is required to evaluate for potential malignancy or infection. In some cases, the lymphadenopathy may be secondary to an intraprocedural hemostatic agent and/or related granulomatous reaction. Case Presentation: We present the case of an 80-year-old female with a remote past medical history of breast cancer status post-lumpectomy and chemoradiation. Twenty years later, a 2.4 cm pulmonary right middle lobe nodule was noted on imaging studies. She underwent bronchoscopy, cervical mediastinoscopy, and right middle lobe wedge resection. The final pathologic diagnosis was a pulmonary carcinoid tumor, and the excised mediastinal LN was negative for malignancy. A 10-month surveillance positron emission tomography scan showed new mildly avid mediastinal and right hilar LNs. The following endobronchial ultrasound-guided transbronchial needle aspiration showed unremarkable lymphoid elements in the enlarged 4R LN, while the station 7 LN demonstrated ample dense hyaline-like foreign material. Subsequent review of the cell block/biopsy and communication with the thoracic surgeon revealed that Surgicel® (or oxidized regenerated cellulose) was placed during surgery at the station 7 site. Discussion/Conclusion: Assessment of the findings and based on the similar histologic appearance reported in previous cases associated with Surgicel® [Ann Thorac Med. 2017;12(1):55–6, Cancer Cytopathol. 2019;127(12):765–70, and Arch Bronconeumol. 2020;56(7):459–71], the station 7 acellular, amorphous, and hyaline-like exogenous material found in our case was interpreted as hemostatic agent compatible with Surgicel® (or oxidized regenerated cellulose). This case highlights the importance of cytologic/histologic recognition of hemostatic agents, specifically oxidized cellulose mesh.

© 2022 S. Karger AG, Basel

References Badenes D, Pijuan L, Curull V, Sanchez-Font A. A foreign body reaction to Surgicel® in a lymph node diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. Ann Thorac Med. 2017;12(1):55–6. Ibrahim MF, Aps C, Young CP. A foreign body reaction to Surgicel mimicking an abscess following cardiac surgery. Eur J Cardiothorac Surg. 2002;22(3):489–90; author reply 490. Oto A, Remer EM, O’Malley CM, Tkach JA, Gill IS. MR characteristics of oxidized cellulose (Surgicel). AJR Am J Roentgenol. 1999;172(6):1481–4. Sugar O. Editorial: oxidized cellulose hemostat (Surgicel). Surg Neurol. 1984;21(5):521. Menovsky T, Plazier M, Rasschaert R, Maas A, Parizel P, Verbeke S. Massive swelling of Surgicel® Fibrillar™ hemostat after spinal surgery. Case report and a review of the literature. Minim Invasive Neurosurg. 2011;54(5–6):257–9. Sabel M, Stummer W. Haemostasis in spine surgery. The use of local agents: Surgicel and Surgifoam. Eur Spine J. 2004;13(Suppl 1):S97–101. Martinez A, Pubul V, Jokh EA, Martinez A, El-Diasty M, Fernandez AL. Surgicel-related uptake on positron emission tomography scan mimicking prosthetic valve endocarditis. Ann Thorac Surg. 2021;112(5):e317–9. Hernandez-Bonilla S, Rodriguez-Garcia AM, Jimenez-Heffernan JA, Munoz-Hernandez P, Palacios-Lazaro E, Lopez-Ferrer P, et al. FNA cytology of postoperative pseudotumoral lesions induced by oxidized cellulose hemostatic agents. Cancer Cytopathol. 2019;127(12):765–70. Díaz Lopez JM, Caballero Vázquez A, López Hidalgo JL, Márquez Lobo B. EBUS-TBNA diagnosis of a granulomatous reaction to Surgicel® in mediastinal adenopathy. Arch Bronconeumol. 2020;56(7):459–71. Article / Publication Details

First-Page Preview

Received: March 17, 2022
Accepted: April 18, 2022
Published online: July 27, 2022

Number of Print Pages: 4
Number of Figures: 1
Number of Tables: 0

ISSN: 0001-5547 (Print)
eISSN: 1938-2650 (Online)

For additional information: https://www.karger.com/ACY

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