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

Abstract

Background Schloffer tumor is a foreign body granuloma in the abdominal subcutaneous layer that develops due to a foreign body such as suture from several months to years postoperatively. Herein, we report a case of a rapidly growing Schloffer tumor with F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) positivity at the port site of laparoscopic sigmoidectomy for colon cancer. Case presentation An 85-year-old man, who underwent laparoscopic sigmoidectomy for stage IIIa sigmoid colon cancer 10 months ago, was referred to our hospital with complaints of a growing mass in the abdominal wall. The tumor was palpable at the right-sided abdominal wall corresponding to the port site of laparoscopic sigmoidectomy. The tumor rapidly grew for 2 months. Computed tomography showed a ring-enhanced mass at the right-sided abdominal wall. PET examination revealed high accumulation of FDG in the tumor. Tumor resection was performed due to suspected port site recurrence. The pathological diagnosis was inflammatory granuloma, so-called Schloffer tumor. Conclusion In the era of laparoscopic surgery, Schloffer tumor may be one of the differential diagnoses for rapidly growing tumor with FDG-PET positivity at the port site in postoperative patients with advanced colorectal cancer.

Laparoscopic excision for small intestinal mesenteric tumour diagnosed Schloffer tumour

“…From a literature search of the PubMed database (using the keywords 'Schloffer tumor'), three similar cases have been reported in English. [ 1 2 3 ] The patients in these cases had histories of laparotomy, but only one case involved a foreign body. [ 2 ]…”

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

“…Schloffer's tumor might be considered the diagnosis in the present case based on the potential etiology because it is possible that Vicryl™ suture or Surgicel™ used in RPN might have provoked a foreign body reaction. Asano et al [5] reported four patients who developed Schloffer's tumors after colorectal surgery; absorbable sutures were used in prior surgeries in all four cases. The time interval was less than one year between the prior surgery and tumor diagnosis in three of these cases.…”

“…IPTs are benign tumors which mimic malignant neoplasms and comprise cells associated with both acute and chronic inflammation. The pathogenesis and etiology of IPTs are unspecific; therefore, IPTs have been described under various names such as xanthogranuloma, inflammatory myofibroblastic tumor [ 1 ], and lipogranuloma [ 4 ] based on histological findings or cellulose granuloma [ 2 ], surgical granuloma [ 3 ], and Schloffer's tumor described as an immune response to foreign bodies used in surgery [ 5 , 7 ] according to the antigens provoking inflammation.…”

“…Inflammatory pseudotumors (IPTs) which are caused by nonspecific inflammatory conditions can develop at nearly every body site [1]. Albeit the very low frequency, several cases of patients who developed IPTs after surgery have been reported even in the era of minimally invasive surgery [2][3][4][5][6]. Distinguishing IPTs from local recurrence or metastasis of malignant neoplasms can be challenging.…”

“…The diagnosis depends primarily on imaging studies; however, there are no distinguishable radiologic features of IPT, which vary according to the histological content and location [1]. Additionally, FDG-PET appears to be impractical as both conditions can display positive FDG-PET uptake [4,5,10].…”