J Endocr Surg.  2018 Sep;18(3):214-217. 10.16956/jes.2018.18.3.214.

Artificial Acellular Dermal Matrix Presenting as a Nodule in Thyroidectomy Patient

• Kim EY
• Lee KH
• Park YL
• Park CH
• Kim DH
• Chae SW
• Yun JS

• KMID: 2420780
• DOI: http://doi.org/10.16956/jes.2018.18.3.214

Abstract

Postoperative adhesion after total thyroidectomy induces discomfort such as pain, hyperesthesia of anterior neck and swallowing difficulty. To prevent postoperative adhesion, various anti-adhesion barriers were introduced. Adhesion barrier are generally considered to be well tolerable and safe, however few cases of delayed adverse effects are reported. Persistent adhesion barrier agent on operation site is one of the rare complications. This study aimed to review the literature, and discuss the etiology and management of persistent artificial acellular dermal matrix (ADM) after thyroidectomy. Herein, we presented a case who presented as a nodule after applying artificial ADM which lasted 32 month post-thyroidectomy. A 64-year-old woman underwent left hemi thyroidectomy and ipsilateral central compartment node dissection (CCND) for papillary thyroid carcinoma (PTC). Seven months later operation, her neck ultrasonography (US) revealed a hypoechoic mass on left operation bed, which was suspicious for recurred mass, granulation tissue or neuroma. After excision of mass, the final histopathologic diagnosis was rolled ADM.

Keyword

Carcinoma; Papillary; Thyroid

MeSH Terms

Acellular Dermis*
Deglutition
Diagnosis
Female
Granulation Tissue
Humans
Hyperesthesia
Middle Aged
Neck
Neuroma
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy*
Ultrasonography

Figure

• 

  Fig. 1 Ultrasonographic image of artificial ADM. (A) Ultrasonographic image showed a hypoehoic mass on the left thyroid operation bed, which is 1.5×1.6 cm in size on transverse view (arrow). (B) A hypoechoic mass was located under strap muscle on longitudinal view (arrow). ADM = acellular dermal matrix.

• 

  Fig. 2 Gross image of artificial ADM. Artificial ADM had initially whitish to yellow colored sleek cut surface. After stained with green dye, cut surface of mass was shown in greenish color (bar=1 cm). ADM = acellular dermal matrix.

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  Fig. 3 Histopathologic result of artificial ADM. (A) H&E staining showed well defined, nodular connective tissue (×12.5). (B) H&E staining depicted increased collagenous bundles in the nodular lesion (×40). (C) Blue colored collagenous bundles are arranged haphazardly (Masson's trichrome stain, ×40). ADM = acellular dermal matrix; H&E = hematoxylin and eosin.

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