case_images: PMC5264175_01
case_images: (a) Lymph node 4R with sinus histiocytosis, anthracosis, and a piece of bronchial cartilage (H and E, x4). (b) Thoracic computed tomography axial section showing the right low paratracheal lymph node of 14 mm
case_images: ATM-12-55-g001.jpg
case_images: PMC5264175_01_ATM-12-55-g001.jpg
case_images: F1
case_images: Lymph node from region 4R had fragments of bronchial cartilage introduced by EBUS-TBNA performed previously [Figure 1a]. One year later, during outpatient thoracic surgery monitoring, thoracic CT evidenced a low right paratracheal lymph node [Figure 1b].
case_images: (a) Endobronchial ultrasound image showing the right low paratracheal lymph node of 12 mm x 11 mm. (b) Right low paratracheal lymph node puncture. Aggregates of acellular amorphous material (birefringent under polarized light) with foreign body type multinucleated giant cells (Papanicolau, x20)
case_images: ATM-12-55-g002.jpg
case_images: PMC5264175_01_ATM-12-55-g002.jpg
case_images: F2
case_images: With the suspicion of pulmonary neoplasm recurrence, EBUS-TBNA was performed [Figure 2a]. The lymphadenopathy cytology showed a nonnecrotizing granulomatous reaction secondary to amorphous fragments of an acellular material that were birefringent under polarized light, compatible with Surgicel  [Figure 2b].