Barbera Giorgio, Lobbia Guido, Ghiozzi Federica, Rovescala Alessandra, Franzina Carlotta, Sina Sokol, Nocini Riccardo
Head and Neck Department, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy.
Unit of Maxillofacial Surgery, Head and Neck Department, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, Italy.
Diagnostics (Basel). 2024 Nov 27;14(23):2667. doi: 10.3390/diagnostics14232667.
This article aims to define the clinical, radiological, and pathological characteristics of non-resorbed oxidised cellulose-induced pseudotumours to raise awareness among surgeons and radiologists, to prevent misdiagnosis, and avoid unnecessary invasive procedures and delays in adjuvant oncological treatments. A systematic review of oxidised resorbable cellulose (ORC)-induced pseudotumours of the head and neck was conducted following PRISMA 2020 guidelines. Articles were retrieved from PubMed, Scopus, Cochrane, and Web of Science. Two ORC-induced pseudotumour cases from the Maxillofacial Surgery Department of Verona are also presented. In most cases, pseudotumours were monitored using ultrasound. Further investigations included CT, MRI, PET-CT, and scintigraphy. Ultrasound images showed stable, elongated, and non-homogeneous masses. In CT scans, pseudotumours showed a liquefied core, and none or only peripheral enhancement. In MRI, pseudotumours presented none or only peripheral enhancement, and a heterogeneous pattern in T2-weighted images. 18-FDG PET scans demonstrated an FDG-avid mass (SUV 7.5). Scintigraphy was inconclusive. Cytology indicated a granulomatous reaction without neoplastic cells. Where surgical excision was performed, a granulomatous reaction with the presence of oxidised cellulose fibres was confirmed. Surgeons should consider artifacts from retained oxidised absorbable haemostatic material when suspecting tumour recurrence or metastasis on postoperative imaging, especially if certain features are present. Fine-needle aspiration cytology (FNAC) is a useful diagnostic tool, but surgical excision may be needed if FNAC is inconclusive or impractical. Collaboration between surgeons and radiologists is essential to avoid misdiagnosis and delays in treatment. Documenting the use and location of haemostatic material in operative reports would aid future understanding of these phenomena.
本文旨在明确未吸收氧化纤维素诱导的假瘤的临床、放射学和病理学特征，以提高外科医生和放射科医生的认识，防止误诊，避免不必要的侵入性操作以及辅助肿瘤治疗的延误。按照PRISMA 2020指南，对氧化可吸收纤维素（ORC）诱导的头颈部假瘤进行了系统综述。文章从PubMed、Scopus、Cochrane和科学网检索。还介绍了维罗纳颌面外科的两例ORC诱导的假瘤病例。在大多数情况下，使用超声监测假瘤。进一步的检查包括CT、MRI、PET-CT和闪烁扫描。超声图像显示肿块稳定、细长且不均匀。在CT扫描中，假瘤显示液化核心，无强化或仅周边强化。在MRI中，假瘤无强化或仅周边强化，在T2加权图像上呈不均匀模式。18-FDG PET扫描显示FDG摄取性肿块（SUV 7.5）。闪烁扫描结果不明确。细胞学检查显示为肉芽肿反应，无肿瘤细胞。在进行手术切除的病例中，证实存在伴有氧化纤维素纤维的肉芽肿反应。当术后影像学怀疑肿瘤复发或转移时，尤其是出现某些特征时，外科医生应考虑残留氧化可吸收止血材料导致的假象。细针穿刺细胞学检查（FNAC）是一种有用的诊断工具，但如果FNAC结果不明确或不实用，可能需要进行手术切除。外科医生和放射科医生之间的合作对于避免误诊和治疗延误至关重要。在手术报告中记录止血材料的使用和位置将有助于未来对这些现象的理解。
