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FNA cytology of postoperative pseudotumoral lesions induced by oxidized cellulose hemostatic agents.

Abstract

BACKGROUND

The use of topically applied hemostatic substances during surgery has become a common practice. In some cases, the material is not absorbed or induces a granulomatous reaction resulting in a pseudotumoral lesion. With imaging studies, it is not possible to differentiate this from a tumor recurrence or abscess. This study describes the authors' cytologic experience with a large series of pseudotumoral lesions induced by oxidized cellulose, one of the most commonly used hemostatic agents. Almost no cytologic descriptions are available in the medical literature.

METHODS

Sixteen patients were evaluated, and the most common sites of fine-needle aspiration (FNA) were the mediastinum and thyroid surgical bed. Other locations were the axilla, neck, vulva, liver, and retroperitoneum. All these lesions appeared after surgical procedures in which oxidized cellulose was used as a topical hemostatic agent. The interval time between surgery and FNA varied from 4 to 46 months with a mean of 15 months.

RESULTS

Cytology samples showed very similar findings. In all cases, foreign-body material with a variable granulomatous reaction was present. Oxidized cellulose was seen as laminated inorganic fragments and most often showed an elongated, quadrangular appearance. Amorphous, ill-defined fragments as well as a dense proteinaceous background with phagocytic cells were also present.

CONCLUSIONS

The current study demonstrates that FNA cytology is a very useful method for the detection of pseudotumoral lesions induced by hemostatic agents. Pathologists must be familiarized with this finding because cytology permits easy differentiation from tumor recurrence.

Authors+Show Affiliations

Department of Pathology, La Paz University Hospital, Madrid, Spain.Department of Pathology, La Paz University Hospital, Madrid, Spain.Department of Pathology, La Princesa University Hospital, Madrid, Spain.Department of Pathology, La Princesa University Hospital, Madrid, Spain.Department of Pathology, La Paz University Hospital, Madrid, Spain.Department of Pathology, La Paz University Hospital, Madrid, Spain.Department of Pathology, La Paz University Hospital, Madrid, Spain.Department of Pathology, La Paz University Hospital, Madrid, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31589810

Citation

Hernández-Bonilla, Silvia, et al. "FNA Cytology of Postoperative Pseudotumoral Lesions Induced By Oxidized Cellulose Hemostatic Agents." Cancer Cytopathology, 2019.
Hernández-Bonilla S, Rodríguez-García AM, Jiménez-Heffernan JA, et al. FNA cytology of postoperative pseudotumoral lesions induced by oxidized cellulose hemostatic agents. Cancer Cytopathol. 2019.
Hernández-Bonilla, S., Rodríguez-García, A. M., Jiménez-Heffernan, J. A., Muñoz-Hernández, P., Palacios-Lázaro, E., López-Ferrer, P., ... Vicandi, B. (2019). FNA cytology of postoperative pseudotumoral lesions induced by oxidized cellulose hemostatic agents. Cancer Cytopathology, doi:10.1002/cncy.22194.
Hernández-Bonilla S, et al. FNA Cytology of Postoperative Pseudotumoral Lesions Induced By Oxidized Cellulose Hemostatic Agents. Cancer Cytopathol. 2019 Oct 7; PubMed PMID: 31589810.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - FNA cytology of postoperative pseudotumoral lesions induced by oxidized cellulose hemostatic agents. AU - Hernández-Bonilla,Silvia, AU - Rodríguez-García,Ana M, AU - Jiménez-Heffernan,José A, AU - Muñoz-Hernández,Patricia, AU - Palacios-Lázaro,Elena, AU - López-Ferrer,Pilar, AU - González-Peramato,Pilar, AU - Vicandi,Blanca, Y1 - 2019/10/07/ PY - 2019/07/19/received PY - 2019/08/28/revised PY - 2019/09/19/accepted PY - 2019/10/8/entrez PY - 2019/10/8/pubmed PY - 2019/10/8/medline KW - Surgicel KW - cytology KW - fine-needle aspiration KW - foreign-body reaction KW - oxidized cellulose KW - pseudotumor JF - Cancer cytopathology JO - Cancer Cytopathol N2 - BACKGROUND: The use of topically applied hemostatic substances during surgery has become a common practice. In some cases, the material is not absorbed or induces a granulomatous reaction resulting in a pseudotumoral lesion. With imaging studies, it is not possible to differentiate this from a tumor recurrence or abscess. This study describes the authors' cytologic experience with a large series of pseudotumoral lesions induced by oxidized cellulose, one of the most commonly used hemostatic agents. Almost no cytologic descriptions are available in the medical literature. METHODS: Sixteen patients were evaluated, and the most common sites of fine-needle aspiration (FNA) were the mediastinum and thyroid surgical bed. Other locations were the axilla, neck, vulva, liver, and retroperitoneum. All these lesions appeared after surgical procedures in which oxidized cellulose was used as a topical hemostatic agent. The interval time between surgery and FNA varied from 4 to 46 months with a mean of 15 months. RESULTS: Cytology samples showed very similar findings. In all cases, foreign-body material with a variable granulomatous reaction was present. Oxidized cellulose was seen as laminated inorganic fragments and most often showed an elongated, quadrangular appearance. Amorphous, ill-defined fragments as well as a dense proteinaceous background with phagocytic cells were also present. CONCLUSIONS: The current study demonstrates that FNA cytology is a very useful method for the detection of pseudotumoral lesions induced by hemostatic agents. Pathologists must be familiarized with this finding because cytology permits easy differentiation from tumor recurrence. SN - 1934-6638 UR - https://www.unboundmedicine.com/medline/citation/31589810/FNA_cytology_of_postoperative_pseudotumoral_lesions_induced_by_oxidized_cellulose_hemostatic_agents L2 - https://doi.org/10.1002/cncy.22194 DB - PRIME DP - Unbound Medicine ER -