Nonabsorbable suture granuloma mimicking ovarian cancer recurrence at combined positron emission tomography/computed tomography evaluation: a case report

Abstract

IntroductionThis is the first case of suture granuloma mimicking isolated ovarian cancer relapse. Only six analogous cases have been previously reported in other malignancies.Case presentationWe report the case of a 44-year-old Caucasian woman with partially platinum-sensitive ovarian cancer in which radiological features, including computed tomography and combined 18F-fluorodeoxyglucose-positron emission tomography/computed tomography, were strongly suggestive of isolated cancer relapse in her right subdiaphragmatic region. Laparoscopic examination resulted negative, but was not completely suitable due to widespread adhesive syndrome. The laparotomy for secondary cytoreductive surgery and biopsy of the suspected area showed inflammatory granuloma caused by nonabsorbable propylene suture, without evidence of neoplastic cells. Moreover, unexpected peritoneal carcinosis was found.ConclusionsThis evidence suggests that clinical details about previous surgical procedures are necessary for adequate interpretation. Although much progress has been made in imaging techniques, especially in the promising field of combined 18F-fluorodeoxyglucose positron emission tomography/computed tomography, these procedures should be still thoroughly investigated in order to promptly rule out tumor recurrence and avoid unnecessary surgery.

A complication of thyroidectomy: Do not forget suture reaction

“…Therefore, it causes a significant inflammation in tissues. For this reason, it should be remembered that reaction may develop against silk suture material (16,17).…”

Rare complication of varicocelectomy: Suture granuloma

“…To date, numerous case studies related to suture granuloma have been reported by different departments, including cases of suture granuloma that occurred after open repair of Achilles tendon rupture (Ergin, Demirel, & Özmen, ) and after thyroidectomy (Abdul Hamid, Yu‐Lin, & Maharani Hassan, ; Soylu et al, ), cases mimicking ovarian cancer recurrence (Imperiale, Marchetti, & Salerno, ), and cases that occurred shortly after gastrectomy and lymphadenectomy (Tsujita et al, ). However, to our knowledge, no case of suture granuloma after varicocelectomy has been reported.…”

Surgicel® granuloma mimicking ovarian cancer: A case report

“…Despite the high accuracy of positron emission tomography (PET)/CT scanning, this method may produce false-positive results in cases of foreign body granuloma, possibly as a consequence of localized inflammation mimicking malignant tissue glucose uptake (14). Imperiale et al (8) reported the case of a patient with ovarian cancer where combined 18 F-fluorodeoxyglucose PET/CT suggested isolated cancer relapse. However, the lesion was surgically removed and demonstrated to be a foreign body granuloma (8).…”

“…Imperiale et al (8) reported the case of a patient with ovarian cancer where combined 18 F-fluorodeoxyglucose PET/CT suggested isolated cancer relapse. However, the lesion was surgically removed and demonstrated to be a foreign body granuloma (8).…”

“…It has been reported that 40% of foreign body reactions are diagnosed within the initial year subsequent to surgery, and 50% are discovered ≥5 years following surgery (6)(7)(8). The majority of these complications occur outside the abdominal cavity, and a limited number of cases of Surgicel ® -associated granuloma linked to gynecological surgery have been reported thus far (6)(7)(8).…”