title: A case of postoperative hepatic granuloma presumptively caused by surgical staples/clipping materials.
abstract: A 66-year-old man with postsigmoidectomy status for colon cancer received laparoscopic partial hepatectomy due to a hepatic mass with employing titanium clips were for a vascular clamp. Histological examination showed liver metastasis from sigmoid colon cancer. Twenty-nine months after the partial hepatectomy, a mass developed on the stump at the hepatic resection. Laparoscopic left lateral segmentectomy was conducted under suspicion of cancer recurrence and an automatic titanium stapling device was used. The macroscopically cut surface of the liver showed a grey-white solid nodule measuring 23 x 20 mm and involving metal clips. The nodule was consistent with granuloma microscopically. Twenty-three months after the segmentectomy, a mass reappeared on the hepatic radial margin and an open left lateral hepatic lobectomy was performed because of its growth tendency. Histopathological examination revealed granuloma similar to the previous instance. Since these nodules formed a granulomatous lesion surrounding metal staples/clips and evidence of caseous necrosis was lacking, granuloma due to surgical staples/clips was suspected. Sporadic case reports of postoperative pulmonary granuloma at the staple line have been published previously, but there are no articles detailing a case involving hepatic granuloma. We present our case as the first report of postoperative staple-line hepatic granuloma.
authors.affiliation: Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan. nihonyanagi@sakura.med.toho-u.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nihon-Yanagi
authors.affiliation: Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan. t-ishiwatari@med.toho-u.ac.jp.
authors.forename: Takao
authors.initials: T
authors.lastname: Ishiwatari
authors.affiliation: Department of General and Gastroenterological Surgery, Toho University School of Medicine, 6-11-1 Omori-Nishi,, 143-8541, Ota-Ku, Tokyo, Japan. yotsuka@med.toho-u.ac.jp.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Otsuka
authors.affiliation: Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan. yoichiro0207@med.toho-u.ac.jp.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Okubo
authors.affiliation: Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan. naobumi.tochigi@med.toho-u.ac.jp.
authors.forename: Naobumi
authors.initials: N
authors.lastname: Tochigi
authors.affiliation: Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan. megumi.wakayama@med.toho-u.ac.jp.
authors.forename: Megumi
authors.initials: M
authors.lastname: Wakayama
authors.affiliation: Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan. tetsuo.nemoto@med.toho-u.ac.jp.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nemoto
authors.affiliation: Division of Gastroenterology and Hepatology; Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan. manabu62@med.toho-u.ac.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of General and Gastroenterological Surgery, Toho University School of Medicine, 6-11-1 Omori-Nishi,, 143-8541, Ota-Ku, Tokyo, Japan. hironori@med.toho-u.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Kaneko
authors.affiliation: Division of Gastroenterology and Hepatology; Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan. sumino@med.toho-u.ac.jp.
authors.forename: Yasukiyo
authors.initials: Y
authors.lastname: Sumino
authors.affiliation: Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan. kaz@med.toho-u.ac.jp.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Shibuya
mesh_terms: D000368:Aged; D001706:Biopsy; D020878:Device Removal; D004867:Equipment Design; D015745:Granuloma, Foreign-Body / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006498:Hepatectomy / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007150:Immunohistochemistry; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D012811:Sigmoid Neoplasms / Q000473:pathology / Q000601:surgery*; D013525:Surgical Instruments / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects*; D013997:Time Factors; D014025:Titanium / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D014025:Titanium