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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 27  |  Issue : 2  |  Page : 184-185

A rare complication following partial nephrectomy for renal cell carcinoma


Division of Urology, Lourdes Institute of Nephro-Urology, Lourdes Hospital, Kochi, Kerala, India

Date of Submission24-Nov-2020
Date of Decision15-Mar-2021
Date of Acceptance21-Mar-2021
Date of Web Publication15-Nov-2021

Correspondence Address:
Dr. H Krishna Moorthy
Division of Urology, Lourdes Institute of Nephro-Urology, Lourdes Hospital, Kochi - 682 012, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ksj.ksj_42_20

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  Abstract 


Partial nephrectomy (PN) is currently the treatment of choice for T1a renal cell carcinoma (RCC). However, the procedure is technically demanding and is associated with some notable complications. Recurrence of tumour and vascular complications are major complications of the procedure. Foreign-body granulomas have been not been reported following PN in literature. In this paper, we present the case report of suture granuloma (foreign-body granuloma) at the resected margin of the kidney in a patient who underwent PN for RCC, which caused a diagnostic dilemma. With the increasing use of a variety of suture materials for closing the resected margin of renal tissue after PN, the possibility of occurrence of foreign-body granulomas (suture granulomas) should also be thought of in the differential diagnosis of locally recurrent masses at the resection site.

Keywords: Foreign-body granuloma, partial nephrectomy, renal cell carcinoma


How to cite this article:
Moorthy H K, Pillai BS. A rare complication following partial nephrectomy for renal cell carcinoma. Kerala Surg J 2021;27:184-5

How to cite this URL:
Moorthy H K, Pillai BS. A rare complication following partial nephrectomy for renal cell carcinoma. Kerala Surg J [serial online] 2021 [cited 2021 Nov 30];27:184-5. Available from: http://www.keralasurgj.com/text.asp?2021/27/2/184/330406




  Introduction Top


Partial nephrectomy (PN) is currently the treatment of choice for T1a renal cell carcinoma. However, the procedure is technically demanding and is associated with some notable complications. Most complications occur in the immediate post-operative period including bleeding, urinomas and infections. Recurrence of tumour and vascular complications are major late complications of the procedure. Foreign-body granulomas have been not been reported following PN in literature.


  Case Report Top


A 66-year-old male manual labourer underwent open PN for enhancing exophytic mass in the lower pole of the left kidney, 4 cm × 3.8 cm size [Figure 1]. The resected margins were closed by cortical renorraphy with 1.0 Vicryl. The post-operative period was uneventful. The histopathology report showed clear cell carcinoma with margins of the resected specimen free of tumour. There were lympho-vascular emboli present.
Figure 1: Preop CT

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At 3 months, the patient had one episode of total painless haematuria which was neglected by the patient. Since the renal function tests were normal, contrast-enhanced computed tomography (CECT) of the abdomen was done at 6 months [Figure 2] and 9 months [Figure 3]. There was a hypodense lesion 6 cm × 4 cm at the lower pole of the left kidney at the margin of PN with focal enhancement on the medial aspect of the lesion. Colour Doppler study showed no evidence of vascular anomaly ruling out the possibility of pseudo-aneurysm and fluorodeoxyglucose (FDG) positron-emission tomography-CT (PET-CT) showed non-avid lesion.
Figure 2: Post op CT at 6 months

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Figure 3: Post op CT at 9 months

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Due to diagnostic dilemma, the patient was subjected to completion left radical nephrectomy. The final histopathology report of the mass was non-specific foreign-body granuloma (suture granuloma) with no evidence of recurrent/residual tumour [Figure 4].
Figure 4: HPE

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  Discussion Top


Granulomatous reaction to a foreign body refers to immunological response to an exogenous material such as surgical suture, gauze, talc, silicon or even endogenous materials like cholesterol. With the increasing use of novel surgical material, the incidence of foreign-body granuloma formation due to iatrogenic factors is on the rise.[1],[2] The granuloma appears as hypoechoic lesion with or without posterior acoustic shadowing and without Doppler flow signals. On CECT images, the lesion may sometimes show rim enhancement. These foreign-body granulomas also show unique appearance on FDG PET-CT scan.[3] Miyake et al. reported some large granulomas with visible embedded foreign bodies (textile) presenting with a characteristic ring-shaped FDG uptake pattern resembling as abscess or tumour with necrosis.[4] In our case, the hypodense lesion was poorly FDG avid causing diagnostic dilemma.

With the increasing use of a variety of suture materials for closing the resected margin of renal tissue after PN, the possibility of occurrence of foreign-body granulomas (suture granulomas) should also be thought of in the differential diagnosis of locally recurrent masses at the resection site.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ. Risk factors for retained instruments and sponges after surgery. N Engl J Med 2003;348:229-35.  Back to cited text no. 1
    
2.
Rappaport W, Haynes K. The retained surgical sponge following intra-abdominal surgery. A continuing problem. Arch Surg 1990;125:405-7.  Back to cited text no. 2
    
3.
Kim EY, Ko EY, Han BK, Shin JH, Hahn SY, Kang SS, et al. Sonography of axillary masses: What should be considered other than the lymph nodes? J Ultrasound Med 2009;28:923-39.  Back to cited text no. 3
    
4.
Miyake KK, Nakamoto Y, Mikami Y, Ishizu K, Saga T, Higashi T, et al. F-18 FDG PET of foreign body granuloma: Pathologic correlation with imaging features in 3 cases. Clin Nucl Med 2010;35:853-7.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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