Oxidized regenerated cellulose granuloma mimicking recurrent mass lesion after laparoscopic nephron sparing surgery

Tzevat Tefik, Oner Sanli, Tayfun Oktar, Omer Baris Yucel, Yasemin Ozluk, Isin Kilicaslan

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

INTRODUCTION: Achieving hemostasis in laparoscopic nephron sparing surgery (LNSS), a technically demanding procedure, is challenging. Absorbable hemostatic agents, such as oxidized regenerated cellulose (ORC) are frequently used for hemostasis in laparoscopic nephron sparing surgery. Retention of this material is a very rare situation. PRESENTATION OF THE CASE: We are presenting a case of ORC granuloma after nephron sparing surgery for renal cell carcinoma (RCC) mimicking recurrent renal mass. A 50-year-old woman diagnosed with upper pole renal mass underwent laparoscopic nephron sparing surgery. Oxidized regenerated cellulose was used to achieve hemostasis for an oozing from the perirenal tissue. Resection confirmed RCC. Imaging at 6th month follow-up revealed a lesion with contrast enhancement at the location of the adrenal gland. Positron emission tomography suggested inflammation or metastasis. Histopathological evaluation of the mass revealed foreign body granuloma. DISCUSSION: Laparoscopic nephron sparing surgery is becoming a standardized treatment of select renal tumors. Hemostatic agents, such as ORC, are frequently used to minimize complications in LNSS. In case of ORC application, which is completely absorbed in 8 weeks, to or to a location with close proximity to the primary resection site, surgical granuloma formation should be considered. However its use should not be discouraged and biopsy may be considered for definitive diagnosis. CONCLUSION: Oxidized regenerated cellulose granuloma may mimic different entities such as including invasive carcinoma. Thus it is of utmost importance, if ORC was used during LNSS, the location and use of this material should be noted precisely.

Original languageEnglish (US)
Pages (from-to)227-230
Number of pages4
JournalInternational Journal of Surgery Case Reports
Volume3
Issue number6
DOIs
StatePublished - 2012

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Keywords

  • Laparoscopic nephron sparing surgery
  • Oxidized regenerated cellulose granuloma
  • Recurrent renal mass
  • Renal cell carcinoma

ASJC Scopus subject areas

  • Surgery

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