Novel Insights from Clinical Practice
Kurian E.M.a· Abu-Hijleh M.b· Lowrey T.R.a· De Las Casas L.E.aaDepartment 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 DetailsFirst-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
AbstractIntroduction: 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.
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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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