Oxidized Regenerated Cellulose (Surgicel®) on Cytology/Histology

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.