Oral Presentations - Pathology and Laboratory Medicine - University ...

OtherLiat Apel-Sarid 1 , Doug Cochrane 2 , Paul Steinbok 2 , Angela Byrne 3 ,Christopher Dunham 11Department of pathology, 2 Department of Neurosurgery, 3 Department of Radiology,British Colombia Children’s HospitalAbstract # 58Liat Apel-Saridavitene-induced necrotizing granulomatousinflammation developing post-craniotomy: a pediatriccase seriesBackround/ObjectivesAvitene or microfibrillar collagen hemostat (MCH) is a partially water insoluble acid salt of purified bovine coriumcollagen processed into microcrystals. It is widely used as hemostat agent by surgeons in many surgical fields includingneurosurgery. Although considered as effective in creating homeostasis, there are several reports of its adverse effect.Reports about reactions mimicking recurrence of tumor or abscesses are described with every body region. They arealso few case reports of Avitene reaction after neurosurgery mimicking recurrence of the tumor, acute disseminatedencephalomyelitis (ADEM) or brain abscess.We are presenting a series of three neurosurgical pediatric cases with characteristic reaction to Avitene, mimickingrecurrence or residual of the tumor or abscess formation.The first case was a 10 years old girl with ganglioglioma of the temporal lobe. At operation Avitene was applied. Sixweeks after the procedure she had recurrent seizures and CT scan showed enhancement along the former surgicalsite. She underwent second surgery and pathological examination revealed granoulomatous foreign body reaction toAvitene.Second case was of a 9 years old boy with anaplastic ependymoma of the left parietal lobe. Five weeks after applyingAvitene in the first surgery and 12 radiotherapy treatments he presented with seizures. CT scan showed markedly ringenhancing lesion at the site of the previous resection cavity with perilesion edema. Craniotomy was performed andpathology examination revealed chronic inflammatory and foreign body reaction with residual Avitene.Third case is of 15 years old girl with occipital cortical dysplasia. Five weeks after the initial procedure, and use ofAvitene, she underwent two more surgeries due to ongoing seizures and MRI suggesting of residual cortical dysplasia.Histological examination showed necrotizing granoulomatous inflammation and residual Avitene.These three cases have characteristic imaging and clinical picture 4 to 6 weeks following the use of Avitene in pediatricneurosurgery. It is important that clinicians as well as pathologists consider this characteristic reaction in theirdifferential diagnosis.Poster Presentations * 2 0 1 069