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

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.


CT scan at 1-month post-operatively: (A) an axial image with a 10 × 11 mm mass, with a fluid collection at operative site (*). (B) a 10 × 11 mm enhancing mass (*)
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Figure 4: CT scan at 1-month post-operatively: (A) an axial image with a 10 × 11 mm mass, with a fluid collection at operative site (*). (B) a 10 × 11 mm enhancing mass (*)

Mentions: On 1 month follow-up, a CT angiography was done before proceeding for the management of the other side. On CT, a small homogenously enhancing (53 to 120 HU) nodular lesion was noted close to the operative site. It measured 10 × 11 mm and there was associated small pocket of fluid collection with no air present within [Figure 4A and B]. No significant change was noted in the appearance of the right renal mass. There was a possibility of a recurrent or residual tumor on the left side, but since we were sure of the surgical margins being free of tumor on intraoperative ultrasound and histopathology, it was thought as an unlikely cause. We counseled the patient and planned close observation with monthly examination using ultrasound and a CT scan at 3 months. A repeat CT scan was done at 3 months and there was a well-defined loculated hypodense perinehpric collection at left lower pole (average CT density 15 HU) with no evidence of enhancing soft-tissue density as seen in the earlier study. This excluded the possibility of residual or recurrent lesion [Figure 5]. Meanwhile, right-sided lesions remained static.


Bolster material granuloma masquerading as recurrent renal cell carcinoma following partial nephrectomy
CT scan at 1-month post-operatively: (A) an axial image with a 10 × 11 mm mass, with a fluid collection at operative site (*). (B) a 10 × 11 mm enhancing mass (*)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: CT scan at 1-month post-operatively: (A) an axial image with a 10 × 11 mm mass, with a fluid collection at operative site (*). (B) a 10 × 11 mm enhancing mass (*)
Mentions: On 1 month follow-up, a CT angiography was done before proceeding for the management of the other side. On CT, a small homogenously enhancing (53 to 120 HU) nodular lesion was noted close to the operative site. It measured 10 × 11 mm and there was associated small pocket of fluid collection with no air present within [Figure 4A and B]. No significant change was noted in the appearance of the right renal mass. There was a possibility of a recurrent or residual tumor on the left side, but since we were sure of the surgical margins being free of tumor on intraoperative ultrasound and histopathology, it was thought as an unlikely cause. We counseled the patient and planned close observation with monthly examination using ultrasound and a CT scan at 3 months. A repeat CT scan was done at 3 months and there was a well-defined loculated hypodense perinehpric collection at left lower pole (average CT density 15 HU) with no evidence of enhancing soft-tissue density as seen in the earlier study. This excluded the possibility of residual or recurrent lesion [Figure 5]. Meanwhile, right-sided lesions remained static.

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.