A case of Schloffer tumor with rapid growth and FDG-PET positivity at the port site of laparoscopic sigmoidectomy for colon cancer

FDG PET/MRI in a Case of Isolated Abdominal Incisional Site Metastasis After Laparoscopic Surgery for Colon Cancer

ABSTRACT

Abdominal-wall metastasis following laparoscopic surgery for colorectal cancer is rare. We describe FDG PET/MRI findings in a case of isolated abdominal incisional site metastasis after laparoscopic surgery for colon cancer. The abdominal-wall metastasis showed slight hyperintensity on T2-weighted fat-suppressed image and intense focal FDG uptake on PET. This case demonstrates the usefulness of FDG PET/MRI in detecting the atypical metastasis from colon cancer.

Polymer clip granuloma mimicking lymph node recurrence: a case report

BACKGROUND

Foreign body granulomas are postoperative inflammatory reactions to surgical materials within the body. Traditionally, sutures have been the leading cause of foreign body granulomas in the abdomen, commonly referred to as "suture granuloma". However, the use of polymer clips in modern surgeries has introduced new challenges, and reports of intra-abdominal foreign body granulomas caused by surgical clips are limited. Herein, we present a case of an intra-abdominal foreign body granuloma formed due to polymer clips.

CASE PRESENTATION

A 45-year-old woman who underwent laparoscopic resection for sigmoid colon adenocarcinoma subsequently developed a suspected lymph node recurrence during follow-up. Imaging showed an enlarging mass adjacent to the inferior mesenteric artery with increased fluorodeoxyglucose uptake. Laparoscopic surgical resection revealed the formation of a foreign body granuloma in response to the polymer clips.

CONCLUSIONS

This case suggests that nonabsorbable polymer clips can induce granulomatous reactions postoperatively, and the appearance of lymph node recurrence may be foreign body granulomas.

Two cases of 18F-FDG-PET/CT positive Schloffer tumor following curative surgery of colon cancer

We report two cases of Schloffer tumor that required resection after radical colon cancer surgery because of suspected lymph node recurrence on contrast-enhanced (CE) CT and 18F-FDG-PET/CT. Case1 is a 69-year-old man with sigmoid colon cancer pStage IIA, and case2 is a 61-year-old man with descending colon cancer pStage IIIB.

Suture granuloma with hydronephrosis caused by ileostomy closure after rectal cancer surgery: a case report

Background

Suture granuloma with hydronephrosis after abdominal surgery is extremely rare. We herein report a successfully treated case of suture granuloma with hydronephrosis caused by ileostomy closure after rectal cancer surgery.

Case presentation

A 63-year-old male underwent laparoscopic low anterior resection with covering ileostomy. Two months after primary operation, ileostomy closure was performed with two layered hand-sewn suture (Albert–Lembert method) using absorbable suture. In that operation, marginal blood vessels in the mesentery were ligated with silk suture. The patient had remained in remission with no evidence of tumor recurrence, however, 2 years and 5 months after primary surgery, a contrast-enhanced computed tomography (CT) scan showed a mass-forming lesion on the right external iliac artery (43 × 26 mm) and hydronephrosis. Positron emission tomography/computed tomography (PET/CT) showed a mass-forming lesion without high accumulation, which obstructed the right ureter. Recurrence could not be ruled out due to the rapid appearance of tumor and hydronephrosis in the short-term period. Thus, the patient underwent laparotomy. The tumor located in the mesentery near the anastomosis of ileostomy closure and it was strongly adherent to the retroperitoneum, which obstructed the right ureter. The adhesion between the tumor and ureter was carefully dissected and tumor resection with partial small bowel resection was then performed with preservation of the ureter using ureteral stents. Pathological examination of the tumor revealed fibrous proliferation of foreign body granuloma. In the resected tumor, sutures with foreign giant cells were found. Therefore, we diagnosed the tumor as silk suture granuloma, which was caused by the silk suture used to ligate blood vessels of the mesentery at the ileostomy closure. The patient remained well with no evidence of tumor recurrence as 5 years after the primary operation of rectal cancer.

Conclusions

Suture granuloma is a rare surgery-related complication in the postoperative surveillance of patients with colorectal cancer. If suture granuloma mimicking local recurrence is a differential diagnosis, it would be important to consider to avoid unnecessary extended resection.

Suture granuloma mimicking local recurrence of colon cancer after open right hemicolectomy: a case report

Background

Foreign body granuloma is a rare surgery-related complication that can masquerade as cancer recurrence during postoperative surveillance. It may therefore deceive clinicians and lead to unnecessary interventions. The case presented herein demonstrates how a foreign body granuloma can be misleading in preoperative radiological studies and why this condition should not be ignored in differential diagnoses during surveillance of patients with previous history of abdominal surgery of any kind.

Case presentation

We report a case of suture granuloma mistaken for recurrent colon cancer, including the clinical history, imaging data, and histopathological photographs. A 60-year-old man was followed up at our institution after open right hemicolectomy 2 years earlier for ascending colon carcinoma. Contrast-enhanced computed tomography and magnetic resonance imaging revealed an infiltrative heterogeneous soft tissue lesion at the right mesenteric root, adjacent to the ileocolic anastomosis. Local recurrence was therefore suspected. We performed exploratory laparotomy, excised the tumor, and sent it for histopathological examination, which confirmed suture granuloma.

Conclusions

Foreign body granuloma is a rare surgery-related complication that should be considered during surveillance following colectomy. Its radiological features may mimic recurrent lesions, thus misleading clinicians and causing unnecessary interventions or further complications.

Laparoscopic excision for small intestinal mesenteric tumour diagnosed Schloffer tumour

This report presents a case of Schloffer tumour at the small intestinal mesentery, mimicking a malignant tumour, treated laparoscopically. Six years prior, a 57-year-old woman underwent laparoscopic salpingo-oophorectomy for a benign, cystic, ovarian tumour, but she had no history of malignancy. She was treated at an outpatient clinic for gastrointestinal complaints and was relieved of these symptoms. Abdominal computed tomography showed an incidental mesenteric tumour of the small intestine, tending toward growth. Due to the tumour's malignant potential, laparoscopic examination was performed. A spherical tumour with a base in the jejunum mesentery was observed. It was removed without damage. The post-operative course was uneventful, and the patient was discharged 3 days after the operation without complications. Histological diagnosis showed this to be a Schloffer tumour, but no malignancy was observed. Unidentified intraperitoneal tumours in patients with surgical histories may be Schloffer tumours, and this should be kept in mind.

Inflammatory Pseudotumor Formation at a Port Site after Robotic Partial Nephrectomy for Renal Cell Carcinoma

Inflammatory pseudotumors (IPTs) are benign masses arising from nonspecific inflammatory conditions including surgical invasion. We herein report the rare case of an IPT mimicking port-site metastasis in a 69-year-old patient who underwent retroperitoneal robotic partial nephrectomy for stage T1a renal cell carcinoma. Radiological examination performed six months after the surgery revealed the presence of a mass underneath the abdominal wall which coincided with a port site. The tumor was resected by laparoscopic transperitoneal approach, and histological examination led to the diagnosis of an IPT that consists of xanthogranulomatous inflammation. We also discuss the etiology of IPT formation and features distinguishing IPTs from port-site metastasis.