Scientific Letter
EBUS-TBNA Diagnosis of a Granulomatous Reaction to Surgicel® in mediastinal adenopathy
Diagnóstico mediante EBUS-TBNA de reacción granulomatosa secundaria a Surgicel® en adenopatía mediastínica
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Note solid linear structure in the air filled cyst (arrow in B). (C) CT 3D volume rendering images before surgery. Hyper radiolucent cystic structures occupy right upper and lower lobes with hyper expansion and herniation of the right lung toward the left. (D) CT 3D volume rendering images after surgery. Right lung volume reduction and persistence of lower lobe cyst structure with minor hyper expansion. (E) Chest radiograph after surgery demonstrates right lung volume and mediastinal shift reduction with persistence of bullae in the right lower lobe. (F) Histologic examination (magnification ×40) of the upper right lobe shows severe evolved emphysema areas with marked alveolar hyper expansion due to air trapping, compressed parenchyma and generalized loss of interstitial connective tissue.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Isabel Garrido Ocaña, Marta González Fernández-Palacios, José Antonio Matute de Cárdenas, María Luisa Rosso González, Elena Merchante García, José Alberto García Bolaños, María José Moreno Valera" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Ana Isabel" "apellidos" => "Garrido Ocaña" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "González Fernández-Palacios" ] 2 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Matute de Cárdenas" ] 3 => array:2 [ "nombre" => "María Luisa" "apellidos" => "Rosso González" ] 4 => array:2 [ "nombre" => "Elena" "apellidos" => "Merchante García" ] 5 => array:2 [ "nombre" => "José Alberto" "apellidos" => "García Bolaños" ] 6 => 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=> array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289620300132?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301075?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000007/v1_202007070735/S1579212920301075/v1_202007070735/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "EBUS-TBNA Diagnosis of a Granulomatous Reaction to Surgicel® in mediastinal adenopathy" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "460" "paginaFinal" => "461" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jose Manuel Díaz López, Alberto Caballero Vázquez, Javier Luis López Hidalgo, Bélgica Márquez Lobo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Jose Manuel" "apellidos" => "Díaz López" "email" => array:1 [ 0 => "josemdiazlopez32@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Alberto" "apellidos" => "Caballero Vázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Javier Luis" "apellidos" => "López Hidalgo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Bélgica" "apellidos" => "Márquez Lobo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Técnicas Broncopleurales y Neumología Intervencionista, Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Anatomía Patológica Provincial de Granada, Hospital Universitario Clínico San Cecilio, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico mediante EBUS-TBNA de reacción granulomatosa secundaria a Surgicel® en adenopatía mediastínica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1512 "Ancho" => 2500 "Tamanyo" => 317107 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest CT scan showing enlarged nodal station 4R. (B) PET/CT with increased metabolism in subcarinal adenopathy. (C) Giant cells with birefringent material (400×) from the first case. (D) Birefringent amorphous material under polarized light from the second case.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report 2 similar cases of diagnosis by pathology study of a granulomatous reaction caused by hemostatic material (oxidized cellulose, Surgicel®) that occurred in 2019 at the Hospital Universitario Virgen de las Nieves in Granada.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first was a 61-year-old patient with no significant medical history, diagnosed with a solitary pulmonary nodule measuring 15<span class="elsevierStyleHsp" style=""></span>mm×20<span class="elsevierStyleHsp" style=""></span>mm in the right inferior lobe. Right lower lobectomy was performed by video-assisted thoracoscopy (VATS) with a histological diagnosis of adenocarcinoma of pulmonary origin. Follow-up computed tomography (CT) showed right lower paratracheal nodes (station 4R) measuring 19<span class="elsevierStyleHsp" style=""></span>mm×16<span class="elsevierStyleHsp" style=""></span>mm, enlarged compared to previous imaging studies, so linear endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) was performed. The pathology study of the node revealed multiple inclusions of birefringent material under polarized light, suggestive of oxidized cellulose (Surgicel®) and cells with evidence of histiocytic/macrophagic reaction to a foreign body. It was subsequently determined that during the surgical process, hemostatic material had been used near the 4R space (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The second case was a 70-year-old man with a history of right lower lobectomy by VATS, with mediastinal lymphadenectomy at 4R and in the subcarinal region (G7) due to a pulmonary nodule measuring 22<span class="elsevierStyleHsp" style=""></span>mm×14<span class="elsevierStyleHsp" style=""></span>mm, with a histologic diagnosis of invasive keratinizing squamous cell carcinoma. In the follow-up CT, enlarged mediastinal nodes were observed, so positron emission tomography (PET/CT) was performed, revealing hypermetabolism at the G7 and right upper paratracheal stations (2R). Nodal neoplastic relapse was suspected, so EBUS-TBNA was performed, showing adenopathy at 2R and a rounded image measuring about 15 mm in its short axis at G7. Three aspirations were made of each lesion in the presence of a cytopathologist, and the initial diagnosis was granuloma. The definitive diagnosis was non-necrotizing giant cell granulomatous reaction and birefringent amorphous material under polarized light, with no neoplastic cells. Similarly, it was confirmed that Surgical® had been used in the adenopathic beds during surgery.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The use of Surgicel® has been widespread in virtually all surgical fields for decades, and its safety and hemostatic properties have been demonstrated, although its mechanism of action is not yet fully clarified. In the vast majority of cases, complete resorption occurs between 1 and 2 weeks after the intervention, starting as soon as 24<span class="elsevierStyleHsp" style=""></span>h post-surgery. Resorption depends on the amount of Surgicel® used in the procedure and the saturation of this material by blood and the tissue bed. Cases of complications due to the excessive use of this hemostat have been documented.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Although a greater number of cases have been reported in cardiovascular,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> maxillary,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and abdominal surgeries, reactions of this nature have also been described in patients undergoing thoracic surgery,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> although this is the first report in the literature of 2 cases. Similar reactions have been described with the inclusion of other materials, such as sutures, talc, and implants,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> and a histological study of the lesion must be performed if a neoplastic process is suspected that cannot be ruled out by other procedures. The presence of this material must be taken into account during the differential diagnosis prior to cytohistological confirmation.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Díaz López JM, Caballero Vázquez A, López Hidalgo JL, Márquez Lobo B. Diagnóstico mediante EBUS-TBNA de reacción granulomatosa secundaria a Surgicel® en adenopatía mediastínica. Arch Bronconeumol. 2020;56:460–461.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1512 "Ancho" => 2500 "Tamanyo" => 317107 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest CT scan showing enlarged nodal station 4R. (B) PET/CT with increased metabolism in subcarinal adenopathy. (C) Giant cells with birefringent material (400×) from the first case. (D) Birefringent amorphous material under polarized light from the second case.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complication due to excessive use of Surgicel" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Patanè" 1 => "E. Zingarelli" 2 => "A. 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Vijaya Nirmala" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Med Allied Sci" "fecha" => "2014" "volumen" => "4" "paginaInicial" => "40" "paginaFinal" => "42" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005600000007/v1_202007070735/S1579212920301087/v1_202007070735/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005600000007/v1_202007070735/S1579212920301087/v1_202007070735/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301087?idApp=UINPBA00003Z" ]
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| 2022 March | 45 | 33 | 78 |
| 2022 February | 19 | 16 | 35 |
| 2021 November | 1 | 0 | 1 |
| 2020 November | 1 | 1 | 2 |
| 2020 October | 2 | 2 | 4 |
| 2020 July | 3 | 0 | 3 |
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