We report the case of a 55-year-old patient, active smoker without occupational exposure who, after the discovery of a pulmonary nodule on thoracic computed tomography (CT), underwent a right upper lobectomy with lymphadenectomy that was diagnostic of pulmonary adenocarcinoma (pT1b pN0). All the lymph nodes sampled in the surgery (10R, 11R, 7, 4R, and 9R) presented sinus histiocytosis and anthracosis and were negative for metastasis. 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]. 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]. The culture and polymerase chain reaction testing for Mycobacterium tuberculosis were negative. At 6 months of follow-up, no significant changes in the lymph node were observed.
(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.