Korean J Radiol.  2009 Jun;10(3):313-318. 10.3348/kjr.2009.10.3.313.

Foreign Body Granulomas Simulating Recurrent Tumors in Patients Following Colorectal Surgery for Carcinoma: a Report of Two Cases

• Kim SW
• Shin HC
• Kim IY
• Baek MJ
• Cho HD

• KMID: 1779461
• DOI: http://doi.org/10.3348/kjr.2009.10.3.313

Abstract

We report here two cases of foreign body granulomas that arose from the pelvic wall and liver, respectively, and simulated recurrent colorectal carcinomas in patients with a history of surgery. On contrast-enhanced CT and MR images, a pelvic wall mass appeared as a well-enhancing mass that had invaded the distal ureter, resulting in the development of hydronephrosis. In addition, a liver mass had a hypointense rim that corresponded to the fibrous wall on a T2-weighted MR image, and showed persistent peripheral enhancement that corresponded to the granulation tissues and fibrous wall on dynamic MR images. These lesions also displayed very intense homogeneous FDG uptake on PET/CT.

Keyword

Foreign bodies; Granuloma; Colon, surgery

MeSH Terms

Adult
Aged
Colorectal Neoplasms/pathology/*surgery
Contrast Media/diagnostic use
Diagnosis, Differential
Fluorodeoxyglucose F18/diagnostic use
Granuloma, Foreign-Body/complications/*diagnosis
Humans
Hydronephrosis/etiology
Image Enhancement/methods
Liver/pathology/radionuclide imaging
Liver Neoplasms/*diagnosis/secondary
Magnetic Resonance Imaging
Male
Pelvic Neoplasms/*diagnosis/secondary
Pelvis/pathology/radiography
Positron-Emission Tomography
Radiopharmaceuticals/diagnostic use
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 67-year-old man with suture granuloma. A. Contrast-enhanced axial CT scan shows ovoid, well-enhancing mass attached to right pelvic side wall (arrows). B, C. This mass shows isointense and hyperintense signal intensity relative to adjacent muscle on T1-weighted (black arrows in B) and fat-saturated T2-weighted MR images (white arrows in C), respectively. D. Coronal gadolinium-benzyloxypropionictetraacetate (Gd-BOPTA) enhanced T1-weighted MR image shows homogeneously enhancing mass (arrow) that invades right distal ureter (double arrows). E. Axial PET/CT fusion image reveals focal FDG uptake in right pelvic side wall (arrow in left). PET/CT fusion image obtained six months later demonstrates interval growth of lesion with intense FDG uptake (arrow in right). F. Photomicrograph of specimen obtained from excisional biopsy shows suture material (double arrows and inset) and multinucleated giant cells (black arrows) (Hematoxylin & Eosin staining, ×400).

• 

  Fig. 2 37-year-old man with foreign body granuloma in liver. A. Contrast-enhanced axial CT scan obtained during portal venous phase demonstrates well-circumscribed, ovoid hypodense mass with peripheral enhancement in segment VI of liver (arrow). B, C. This mass is hypointense relative to liver on T1-weighted MR image (arrow in B) and hyperintense on T2-weighted MR image (arrow in C). Hypointense rim (double arrows in C) is present at peripheral portion of mass on T2-weighted MR image. D. Serial gadolinium-benzyloxypropionictetraacetate (Gd-BOPTA) dynamic MR images show persistently peripheral enhancement of mass (black arrows) from arterial (AP) to delayed phases (DP). PVP = portal-venous phase E. Axial PET/CT fusion image reveals intense homogeneous uptake (arrow). F. Histological examination (Hematoxylin & Eosin staining, ×40) reveals that mass has thin, fibrous wall (F) and contains granulation tissues with inflammatory cells (G) and necrotic areas (N). L = normal liver. High-power photomicrograph (inset, Hematoxylin & Eosin staining, ×200) shows foreign body granuloma composed of multiple multinucleated giant cells (black arrows). White arrow indicates foreign body material that has been engulfed by giant cell.

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