Department of Anatomic Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Internal Medicine, Pulmonary Critical Care Medicine/Interventional Pulmonary, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Acta Cytol. 2022;66(6):556-559. doi: 10.1159/000525857. Epub 2022 Jul 27.
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.
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.
对于有恶性肿瘤病史的患者，需要对淋巴结 (LNs) 进行随访监测，以评估潜在的恶性肿瘤或感染。在某些情况下，淋巴结病可能是由于术中止血剂和/或相关肉芽肿反应引起的。
我们报告了一例 80 岁女性患者，既往有乳腺癌病史，行乳房肿瘤切除术和放化疗。20 年后，影像学检查发现右肺中叶 2.4cm 结节。她接受了支气管镜检查、颈纵隔镜检查和右中叶楔形切除术。最终的病理诊断为肺类癌肿瘤，切除的纵隔淋巴结无恶性肿瘤。10 个月的随访正电子发射断层扫描显示新的轻度活性纵隔和右肺门淋巴结。随后的支气管内超声引导经支气管针吸活检显示在增大的 4R 淋巴结中无明显的淋巴样成分，而站 7 淋巴结显示大量致密的玻璃样样物质。随后对细胞块/活检进行评估，并与胸外科医生沟通，结果显示 Surgicel®（或氧化再生纤维素）在站 7 部位手术时放置。
讨论/结论：根据与 Surgicel®相关的类似组织学表现的评估结果[Ann Thorac Med. 2017;12(1):55-6, Cancer Cytopathol. 2019;127(12):765-70, and Arch Bronconeumol. 2020;56(7):459-71]，我们病例中发现的站 7 无细胞、无定形和玻璃样的外源性物质被解释为与 Surgicel®（或氧化再生纤维素）相容的止血剂。该病例强调了细胞病理学/组织学识别止血剂的重要性，特别是氧化纤维素网。
