A 77-Year-Old Man with a Pulse Granuloma of the Descending Colon Identified by Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) Imaging 19 Months Following Surgical Resection for Rectal Carcinoma

Abstract

Patient: Male, 77-year-old Final Diagnosis: Pulse granuloma Symptoms: None Medication:— Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Oncology Objective: Challenging differential diagnosis Background: Food particles may sometime lodge in the intestinal wall, resulting in a granuloma. Pulse granuloma is associated with the seed of a legume and has a characteristic appearance on histology. This report describes a case of pulse granuloma of the descending colon identified by fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging. Imaging was done 19 months after surgical resection for rectal carcinoma, and the results of imaging alone suggested a tumor metastasis. Case Report: A 77-year-old man underwent sigmoid colostomy for sigmoid colon perforation due to obstruction by rectal cancer affecting the upper rectum approximately 2 years ago. Two months later, after his general condition improved, he underwent laparoscopic low anterior resection. On postoperative pathological examination, the lesion was diagnosed as stage II. Nineteen months later, computed tomography showed an irregular nodule on the dorsolateral side of the descending colon. FDG-PET revealed positive results, and peritoneal dissemination was suspected. Because the lesion was localized and there was no other evidence of metastasis, resection was performed. A pathological examination revealed a pulse granuloma with a central legume seed, and no obvious malignant findings were observed. Conclusions: This report has highlighted the importance of imaging and histopathology in cases in which a solitary nodule is present in the bowel in a patient with previous successful treatment for malignancy. Pulse granuloma, or other types of granuloma associated with impacted food material, may be a cause of a solitary nodule, or pseudotumor, in the bowel wall.

Pulse Granuloma After Tunneled Nasolabial Island Flap: An Unusual Cause for a Cutaneous Nodule on the Face

“…Although perineural invasion (PNI) has been extensively documented, only a few cases featuring intravascular invasion have been reported, with its clinical significance yet to be determined. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] We present the case of an 85-yearold White woman with no history of cutaneous malignancy. She presented with an erythematous lesion of unknown duration on the nasal dorsum.…”

“…Aggressive histological subtypes of BCC, such as infiltrative, basosquamous, and morpheaform, have been linked to a higher likelihood of metastasis and recurrence. 7,9 These variants are often characterized by increased tumor vascularity, which can be assessed using immunohistochemical stains to highlight the extension of microvessels. The infiltration of tumor cells into blood vessels not only promotes tumor growth by enhancing the blood supply but also creates potential pathways for the local and distant dissemination of cancer cells.…”

“…2 Unusual extraoral locations, such as the gynecological and gastrointestinal tract, lungs, skin, or gallbladder, have been described as a consequence of chronic inflammatory conditions or a surgical complication. [3][4][5][6][7][8][9] Very few cases have been reported on the skin. [10][11][12][13][14][15] Very rarely, cases of PG mimicking a primary malignancy in the urothelial tract, 4,5 ovary, 1 gastrointestinal tract, or gallbladder [6][7][8] or the recurrence of a previously diagnosed neoplasia in the gastrointestinal or urothelial tract 4,7,9 have been reported.…”

“…[3][4][5][6][7][8][9] Very few cases have been reported on the skin. [10][11][12][13][14][15] Very rarely, cases of PG mimicking a primary malignancy in the urothelial tract, 4,5 ovary, 1 gastrointestinal tract, or gallbladder [6][7][8] or the recurrence of a previously diagnosed neoplasia in the gastrointestinal or urothelial tract 4,7,9 have been reported.…”

“…Unusual extraoral locations, such as the gynecological and gastrointestinal tract, lungs, skin, or gallbladder, have been described as a consequence of chronic inflammatory conditions or a surgical complication. 3–9 Very few cases have been reported on the skin. 10–15…”