Objectives Introduction: Suture granuloma is a rare benign tumor caused by suture material, which usually appears several months or years after surgery. It may look identical to tumor relapse or metastatic disease on CT, PET scans and MRI, requiring histopathologic confirmation. An electronic literature search was undertaken using Medline, PubMed and Cochrane library databases for cerclage suture granuloma cases, using terms ‘cerclage’, ‘suture granuloma’, ‘cervical cancer’ ‘metastasis’ and boolean operators AND or OR, without any findings.
Methods Presentation of case: 31 years-old with cervical cancer IB1 in 2014. She underwent radical trachelectomy, laparoscopic limphadenectomy and cerclage as fertility-sparing treatment. The patient attended for regular follow-up during 4 years, without signs of recurrence. 6 years after treatment, presented vaginal bleeding and fetid discharge. Physical examination: 1cm exophytic bleeding lesion on anterior cervical-vaginal recess. Two biopsies were realized without any concluding findings. Pelvic MRI evidenced a cystic lobulated formation with thick walls, vascularized septs presenting wide contact with vesical trigon measuring 2.2x1.5x2.4cm, and an enlarged lymphnode in internal iliac chain of 1.3cm. Considering the risk of malignancy, the patient was submitted to laparoscopic resection of the lesion and lymphnode dissection.
Results The final analysis resulted in granulation tissue with no signs of malignancy in lesion or in lymphnode, thus excluding the hypothesis of malignant recurrence or metastasis.
Conclusions Discussion: Foreign body granuloma may look identical to tumor relapse or metastatic disease on image exams, thus requiring histopathological confirmation. However, the hypothesis of granulomatous reactions involving cerclage non-absorbable suture must be a differential diagnosis in clinical practice.
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