Postoperative cytological findings from the use of the Integran microfibrillar collagen hemostatic matrix in conization

Abstract

The Integran microfibrillar collagen hemostatic matrix is one form of microfibrillar collagen hemostat. This form has a sheet-type structure and has explicitly been used in Japan. In gynecology, this sheet-type matrix has helped effect uterine surface hemostasis, especially in myomectomy and cervical conization. However, cytotechnologists and pathologists have overlooked the foreign materials used for conization in postoperative cervical cytology. We report two cases describing the characteristic cervical cytology findings when Integran was used in conization. The first case was a 67-year-old woman who underwent conization because of cervical intraepithelial neoplasia (CIN) 3. Thirty-six days after the surgery, many cylindrical fragments of glossy acellular materials appeared in the cervical cytology. Fortunately, the content did not impede the diagnosis of NILM. The patient then underwent hysterectomy two months after conization. Surgical specimen revealed a high degree of inflammation and granulation without malignancy. Following surgery, the cylindrical fragments disappeared from microscopic findings. The second case was a 45-year-old woman who underwent conization because of CIN3. Thirty-four days after the surgery, many tubular pieces of glossy acellular materials appeared in cervical cytology, as seen in the first case. The cytological diagnosis was NILM. One hundred days after surgery, cervical cytology revealed many clue cells but no cylindrical fragments. These clusters of cylindrical fragments of glossy acellular materials in cervical cytology after conization might induce a delay in diagnosing the persistence and recurrence of cervical cancer. This article is the first report describing cervical cytology findings associated with Integran use.

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

“…Very few cases mentioning cytology have been previously reported in the medical literature, and there have been only 2 concerning the use of oxidized cellulose . Two other cases are related to the use of other hemostatic agents (Floseal and Integran microfibrillar collagen hemostatic matrix) that do not use oxidized cellulose but instead use thrombin and collagen …”

“…11,12 Two other cases are related to the use of other hemostatic agents (Floseal and Integran microfibrillar collagen hemostatic matrix) that do not use oxidized cellulose but instead use thrombin and collagen. 13,14 The cytologic image is so characteristic that the diagnosis is straightforward with few differential diagnostic considerations. Half of the cases had no significant granulomatous reaction, and smears showed only oxidized cellulose material.…”

“…Image studies do not allow a precise diagnosis, so many of these patients undergo a second surgical procedure because of suspected tumoral recurrence. Cytologic descriptions of pseudotumoral lesions related to hemostatic agents (including oxidized cellulose) are scarce and, to our knowledge, limited to isolated case reports . In this report, we describe our experience with a large series of cases that were studied with fine‐needle aspiration (FNA).…”

“…Cytologic descriptions of pseudotumoral lesions related to hemostatic agents (including oxidized cellulose) are scarce and, to our knowledge, limited to isolated case reports. [11][12][13][14] In this report, we describe our experience with a large series of cases that were studied with fine-needle aspiration (FNA). As shown, cytology permits a precise recognition of…”

Pseudotumoral reaction against oxidized cellulose (Surgicel®) in a post-COVID19 tracheostomy scar

“…Cytology has demonstrated that it is capable of a speci c recognition of pseudotumoral reactions induced by oxidized cellulose (1)(2)(3)(4). Cases that simulate tumor recurrence have been described after almost all types of surgical procedures in which this hemostatic agent has been used.…”