Nodular fasciitis growing at the port site of robotic surgery for rectal cancer
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CASE REPORT
Nodular fasciitis growing at the port site of robotic surgery for rectal cancer Atsushi Yamamoto, Shinji Furuya*, Koichi Takiguchi, Makoto Sudo, Katsutoshi Shoda, Hidenori Akaike, Naohiro Hosomura, Yoshihiko Kawaguchi, Hidetake Amemiya, Hiromichi Kawaida, Hiroshi Kono and Daisuke Ichikawa
Abstract Background: Nodular fasciitis (NF) is a type of rare and rapidly growing tumor that affects the muscular fascial layers. Due to its locally aggressive nature and rapid growth, NF can be mistaken as a malignant process on either clinical or histological grounds. Case presentation: A 61-year-old man was affected by rectal cancer. We performed a robotic, high-anterior resection with lymph node dissection. According to the 8th edition of Union for International Cancer Control, the diagnosis was stage I pT2N0M0. During a routine follow-up 1.5 years after the robotic surgery, a computed tomography examination revealed a tumor in the upper right abdominal wall, at the site of the surgical port, that measured 45 mm. Magnetic resonance imaging indicated a hypo-intensive mass within the right straight muscle of the abdomen. Port site recurrence following the robotic surgery for rectal cancer was suspected, and an ultrasound-guided fine-needle aspiration was performed; it revealed a low-grade myofibroblastic tumor or benign neoplasm, but was inconclusive. We performed an excision of the lesion, and histopathology confirmed NF, seen as a solid, nodular, spindle-cell lesion. The patient was postoperatively followed for more than 1 year without any sign of recurrence of either cancer or NF. Conclusions: NF is histologically benign, but local recurrence frequently occurs. We encountered a patient with NF at the port site after robotic surgery for rectal cancer. Keywords: Nodular fasciitis, Port site after robotic surgery, Rectal cancer Background Nodular fasciitis (NF), described for the first time by Konwaler et al. [1], is a type of rare and rapidly growing tumor that affects the muscular fascial layers. Due to its locally aggressive nature and rapid growth, NF can be mistaken as a malignant process on either clinical or histological grounds. Despite this, NF can be definitively managed via surgical excision, and recurrence is unlikely. Here, we describe a case of fascial NF, and reference the current understanding on NF’s clinical presentation, radiological and histological features, and management. When considering fast-growing masses, NF must be *Correspondence: [email protected] First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409‑3898, Japan
raised as a potential diagnosis. A misdiagnosis of NF as a malignancy on clinical or histological grounds can lead to an unnecessarily wide excision; in most cases, lesions present by growing rapidly over months, and malignancy may be suspected. On a computed tomography (CT) examination, intra-muscular lesions may not appear to be circumscribed, raising a concern of malignancy. In magnetic resonanc
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