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Reaction to a surgical implant foreign body masquerading as recurrent uterine sarcoma
Abigail T Shaltz1, Charles A Leath, James F Wiedenhoefer
1From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Department of Diagnostic Radiology, Brooke Army Medical Center, Fort Sam Houston, Texas; and the Department of Obstetrics and Gynecology, Womack Army Medical Center, Fort Bragg, North Carolina.
Background:
Multiple products to prevent adhesions or lessen the risk of soft tissue attachments are commercially available. The long-term nature of these products is unknown, and they may cause foreign body reactions masquerading as recurrent disease in patients with cancer.
Case:
A perimenopausal female underwent a hysterectomy and placement of a surgical implant, polylactic acid. Final pathology revealed stage IA low-grade endometrial stromal sarcoma. Areas suspicious for recurrence were noted on radiographic imaging 1 year later, resulting in exploratory surgery. The suspicious areas were found to be foreign body reactions. Mass spectrometry identified the main component of the reactions as polylactic acid.
Conclusion:
Adhesion barriers and other surgical implants may not always be completely metabolized and should be used with caution in patients with cancer.