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Post-nephrectomy foreign-body granuloma in the retroperitoneum mimicking lymph node metastasis of renal cell cancer

Authors Luo J, Mao Y, Cai S, Shen X, Chen S, Xie L

Received 11 July 2014

Accepted for publication 25 September 2014

Published 20 November 2014 Volume 2014:7 Pages 2137—2141


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5

Editor who approved publication: Dr Jianmin Xu

Jindan Luo,1,* Yeqing Mao,1,* Songliang Cai,1 Xiaoyong Shen,2 Shanwen Chen,1 Liping Xie1

1Department of Urology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, People’s Republic of China; 2Department of Radiology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, People’s Republic of China

*These authors contributed equally to this work

Abstract: Recently, iatrogenic foreign-body granuloma has been increasingly reported. The asymptomatic presentation and confusing appearance of granuloma can lead to misdiagnosis of a secondary malignancy, especially for a patient with a corresponding past medical history. Sometimes, surgical treatment is unavoidable, and the diagnosis relies upon the pathologic result. Herein, we report an unusual case of a 43-year-old man who underwent a nephrectomy for renal cell carcinoma (clear cell type) 5 years ago. A secondary granuloma was identified behind the inferior vena cava in the retroperitoneum 6 months after the surgery, but the radiologists had failed to identify it throughout the 4 years of routine examination. Later on, the lesion was identified by positron emission tomography, which classified it as a highly 18F-fluorodeoxyglucose-avid lesion. Considering no visible foreign-bodies identified on images, the lesion was arguably diagnosed as a lymph node metastasis of renal cancer. Finally, it was confirmed as a foreign-body granuloma encasing surgical suture and adipose tissue by the pathological analysis.

Keywords: iatrogenic foreign-body granuloma, positron emission tomography, 18F-fluorodeoxyglucose, renal cell carcinoma

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