PMC5264175_01
(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
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F1
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].
(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)
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F2
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].