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Bolster material granuloma masquerading as recurrent renal cell carcinoma following partial nephrectomy

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ABSTRACT

Nephron sparing surgery has seen a phenomenal rise in its application over the past few decades. The use of Surgicel and gel foam for closure of defect created after partial nephrectomy has become a routine practice at many centers. In this case report, we describe radiological artifact secondary to a surgical bolster mimicking a residual disease or an early recurrence in the kidney. This case highlights two facts; first, reapproximation of the renal tissue is best done without the use of Surgicel bolsters. Second, bolsteroma should always be kept in mind as a differential diagnosis in a case where computed tomography (CT) imaging is showing early recurrence. If the surgeon is sure about the surgical margins being negative and the CT image shows a bolsteroma, the patient should be observed and a repeat scan should be done at 3–6 months, which would show regression or disappearance of the lesion proving it to be an artifact rather than malignant lesion.

No MeSH data available.


Preoperative CT scan images: (A) An axial image with an enhancing left renal mass; (B) an axial image with an enhancing right renal mass; (C) an MIP image demonstrating bilateral renal mass
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Figure 1: Preoperative CT scan images: (A) An axial image with an enhancing left renal mass; (B) an axial image with an enhancing right renal mass; (C) an MIP image demonstrating bilateral renal mass

Mentions: A 71-year-old gentleman presented with a history of lower urinary tract symptoms and single episode of painless hematuria 2 years prior to presentation. An ultrasound examination revealed 5 cm, partially exophytic left lower polar mass with a normal right kidney. For characterization of the right renal mass, 5 mm thick, contiguous, multiphasic helical contrast enhanced CT was done using GE™ Bright Speed 16 Slice CT scanner (GE Health Care™, Chicago, USA). 100 ml of iopromide (Ultravist™ 370 mg l/ml) was used as intravenous contrast and images were acquired before (plain axial images), during (corticomedullary phase after a 25 s delay), and after (nephrographic phase after a 120 s delay) injection of contrast. CT revealed a well circumscribed, 5.8 × 5.5 × 5.6 cm size, exophytic, heterogeneously enhancing soft tissue mass arising from the lower pole cortex of the left kidney without any infiltration of pelvicalyceal system (PCS) and preserved perinephric fat planes [Figure 1A–C]. In addition, the right kidney showed two masses similar in characteristics to the left kidney mass; the first one was arising from lower pole cortex and measured 1.8 × 2.1 × 1.9 cm in size, and the second mass was arising from mid interpolar region at the corticomedullary junction without any significant invasion into the calyceal system and measured 1.0 × 0.9 cm in size [Figure 1A–C].


Bolster material granuloma masquerading as recurrent renal cell carcinoma following partial nephrectomy
Preoperative CT scan images: (A) An axial image with an enhancing left renal mass; (B) an axial image with an enhancing right renal mass; (C) an MIP image demonstrating bilateral renal mass
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036333&req=5

Figure 1: Preoperative CT scan images: (A) An axial image with an enhancing left renal mass; (B) an axial image with an enhancing right renal mass; (C) an MIP image demonstrating bilateral renal mass
Mentions: A 71-year-old gentleman presented with a history of lower urinary tract symptoms and single episode of painless hematuria 2 years prior to presentation. An ultrasound examination revealed 5 cm, partially exophytic left lower polar mass with a normal right kidney. For characterization of the right renal mass, 5 mm thick, contiguous, multiphasic helical contrast enhanced CT was done using GE™ Bright Speed 16 Slice CT scanner (GE Health Care™, Chicago, USA). 100 ml of iopromide (Ultravist™ 370 mg l/ml) was used as intravenous contrast and images were acquired before (plain axial images), during (corticomedullary phase after a 25 s delay), and after (nephrographic phase after a 120 s delay) injection of contrast. CT revealed a well circumscribed, 5.8 × 5.5 × 5.6 cm size, exophytic, heterogeneously enhancing soft tissue mass arising from the lower pole cortex of the left kidney without any infiltration of pelvicalyceal system (PCS) and preserved perinephric fat planes [Figure 1A–C]. In addition, the right kidney showed two masses similar in characteristics to the left kidney mass; the first one was arising from lower pole cortex and measured 1.8 × 2.1 × 1.9 cm in size, and the second mass was arising from mid interpolar region at the corticomedullary junction without any significant invasion into the calyceal system and measured 1.0 × 0.9 cm in size [Figure 1A–C].

View Article: PubMed Central - PubMed

ABSTRACT

Nephron sparing surgery has seen a phenomenal rise in its application over the past few decades. The use of Surgicel and gel foam for closure of defect created after partial nephrectomy has become a routine practice at many centers. In this case report, we describe radiological artifact secondary to a surgical bolster mimicking a residual disease or an early recurrence in the kidney. This case highlights two facts; first, reapproximation of the renal tissue is best done without the use of Surgicel bolsters. Second, bolsteroma should always be kept in mind as a differential diagnosis in a case where computed tomography (CT) imaging is showing early recurrence. If the surgeon is sure about the surgical margins being negative and the CT image shows a bolsteroma, the patient should be observed and a repeat scan should be done at 3–6 months, which would show regression or disappearance of the lesion proving it to be an artifact rather than malignant lesion.

No MeSH data available.