PET-positive suture granuloma of abdominal wall 56 years post-appendicectomy mimicking recurrence of lymphoma

• Published in: BMJ case reports Vol. 16; no. 2
• Main Authors: Gaylard, Aubrey, Goai, Xin Yi, Du Guesclin, Alexandra, Hodgson, Russell
• Format: Journal Article
• Language: English
• Published: England 07-02-2023
• Subjects: Abdominal Wall; Fluorodeoxyglucose F18; Foreign-Body Reaction; Granuloma; Humans; Lymphoma, Follicular; Neoplasm Recurrence, Local - diagnosis; Positron-Emission Tomography; Sutures; malignant and benign haematology; pathology; surgical oncology
• ISSN: 1757-790X
• DOI: 10.1136/bcr-2022-254413

We present a unique case of a positron emission tomography (PET)-positive suture granuloma deep to an appendicectomy abdominal wall scar from 56 years prior in a patient with treated lymphoma. The lesion was first detected 8 years ago on a PET scan for new diagnosis of follicular lymphoma, with stable appearances 6 and 7 years later at follow-up. Ultrasound-guided biopsy and flow cytometry of the specimen could not exclude an untreated or recurrent lymphoma; thus, the patient underwent resection of the right iliac fossa abdominal wall lesion. Histopathology results noted granulomatous inflammation surrounding foreign material. The patient had an uneventful postoperative recovery and was discharged from surgical services. In this paper, we review the current literature and discuss the dilemma involved in the diagnosis and management of suture granulomas.