PICTURES IN DIGESTIVE PATHOLOGY

 

Non-absorbable suture granuloma mimicking a retroperitoneal metastatic implant in a patient with sigmoid neoplasm

Granuloma por hilo de sutura no reabsorbible como simulador de implante metastásico retroperitoneal en paciente con neoplasia de sigma

 

 

Alberto Martínez-Martínez and Jade García-Espinosa

Department of Radiodiagnosis. Complejo Hospitalario Universitario de Granada. Granada, Spain

 

 

Introduction

A high percentage of patients operated on for colorectal carcinoma (around 40%) develop local recurrence or metastatic disease (1). The formation of a granuloma from non-absorbable suture material within the abdominal cavity is an uncommon condition following intestinal surgery. On occasion, such reactions are mistaken for abscesses or tumors, with patients undergoing unnecessary therapies (2).

Some cases have been reported of a granuloma arising from non-absorbable suture or textile material that mimicks a neoplastic lesion (1-3), their location being exceptional in the retroperitoneum mimicking a tumor implant in patients having undergone colectomy for colorectal cancer.

 

Case Report

A 66-year-old male with a history of sigmoid adenocarcinoma exhibited a preoperatively absent retroperitoneal nodule at his first follow-up CT scan three months after surgery (Fig. 1). PET-CT confirmed the presence of a retroperitoneal hypermetabolic focus (Fig. 2). A tumor implant was suspected which prompted resection. A pathological study demonstrated fibroadipose tissue with foreign body (suture)-related granulomatous infiltration and absence of tumor cells.

 

 

 

Discussion

The development of a foreign body granuloma from non-absorbable suture material is a relatively uncommon condition that most commonly occurs in response to silk suture in patients with clinical impairment or immunocompromised subjects (1,2). It is characterized by a build-up of histiocytes and multinucleated giant cells around the foreign body. Its primary importance lies on its ability to mimick tumors on imaging techniques.

Peritoneal cases mimicking a tumor in patients with colorectal cancer have been reported (1,4), their retroperitoneal location being exceptional.

Most common descriptions on CT images reflect a nodule with annular enhancement with an iodinated contrast, and peripheral 18-FDG uptake on PET scans (1,4). Homogeneous contrast enhancement and 18-FDG uptake occurs less frequently (1).

Foreign body granuloma from suture is a condition potentially indistinguishable from tumor recurrence or metastatic disease on CT and PET-CT scans, thus requiring pathology confirmation.

 

References

1. Kim SW, Shin HC, Kim IY, et al. Foreign body granulomas simulating recurrent tumors in patients following colorectal surgery for carcinoma: A report of two cases. Korean J Radiol 2009;10:313-8. DOI: 10.3348/kjr.2009.10.3.313.         [ Links ]

2. Imperiale L, Marchetti C, Salerno L, et al. Nonabsorbable suture granuloma mimicking ovarian cancer recurrence at combined position emission tomography/computed tomography evaluation: A Case Report. J Med Case Rep 2014;8:202. DOI: 10.1186/1752-1947-8-202.         [ Links ]

3. Erdogan D, Bozkurt C, Özmen Ö, et al. Foreign body reaction with high standard uptake value level in 18-FDG PET/CT mimicking relapse in an 8-year-old patient diagnosed with Hodgkin lymphoma: A Case Report. Eur J Pediatr Surg Rep 2013;1:60-2. DOI: 10.1055/s-0033-1345278.         [ Links ]

4. Lim JW, Tang CL, Keng GH. False positive F-18 fluorodeoxyglucose combined PET/CT scans from suture granuloma and chronic inflammation: Report of two cases and review of literature. Ann Acad Med Singapore 2005;34:457-60.         [ Links ]