Unusual behavior of foreign body granuloma that grew rapidly in the radiation field during radiation therapy

Abstract

We report our experience with two cases of a rapidly growing benign tumor in the radiation field despite radiotherapy. Case 1 was a 75-year-old man who was diagnosed as having postoperative recurrence of esophageal carcinoma in the right chest wall and underwent radiotherapy. A small nodule in the recurrent lesion grew to 20 mm in diameter at 70 Gy. The biopsy specimen was diagnosed as foreign body granuloma (FBG) with no malignancy. Case 2 was a 78-year-old woman who was diagnosed with axillary lymph node metastases of operated lung cancer and underwent lymphadenectomy and postoperative radiotherapy. No subcutaneous tumor was seen at the beginning of radiotherapy. However, a small nodule appeared in the radiation field at 40 Gy, and it had grown to 30 mm in diameter at 70 Gy. The biopsy specimen was diagnosed as FBG, showing granulation because of a remnant of surgical suture. Both FBGs disappeared within 3-6 months after radiotherapy. In cases in which a tumor has arisen from a site where surgical treatment had been performed and the tumor shows unnatural growth despite radiotherapy, FBG should be considered in the differential diagnosis.

Suture granulomas developing after the treatment of oral squamous cell carcinoma

“…The granuloma in the present case also developed only 9 weeks after surgery. Moreover, in the previous two cases and our case, the lesion developed on the surface of the skin in the radiation field, not in a body cavity [ 7 ]. Radiation therapy may influence the development of these granulomas [ 7 , 8 ].…”

“…Moreover, in the previous two cases and our case, the lesion developed on the surface of the skin in the radiation field, not in a body cavity [ 7 ]. Radiation therapy may influence the development of these granulomas [ 7 , 8 ]. Yamamoto et al reported that the development of a foreign body granuloma may be associated with an immunoreaction of macrophages [ 2 ].…”

“…In one case, the granuloma developed on the chest wall skin after radiation therapy for esophageal cancer with chest wall metastasis. In the other case, the granuloma developed and enlarged in the surgical site during adjuvant radiation therapy after surgery for axillary lymph node metastasis from lung cancer [ 7 ]. Although suture granulomas have been reported to develop several years after surgery, those in the two cases reported by Nomiya et al developed as early as 9 and 2 months after surgery, respectively.…”

Subkutane „Perlschnur“ nach Neck-Dissection unter adjuvanter Radiatio

“…In diesem Fall konnte jedoch aufgrund der Lokalisation und Formation der knotigen Veränderungen am ehesten von der Bildung mehrerer Fadengranulome entlang der Neck-Dissection-Narbe ausgegangen werden. Fadengranulome entstehen aufgrund der zellulären Immunantwort von Makrophagen auf das Fremdmaterial [5]. Durch die ionisierende Gammastrahlung kann das Nahtmaterial degradiert werden [4,7], wodurch Antigene entstehen, die zu einem Trigger und einer Angriffsfläche für Aufgrund der ebenfalls pulmonal und mediastinal vorhandenen vergrößerten Lymphknoten wäre diese Differenzialdiagnose durchaus möglich.…”