Caseating Granulomata Caused by Hemostatic Agent Posing as Metastatic Leiomyosarcoma

BACKGROUND As the number of minimally invasive and laparoscopic procedures increases, hemostatic agents are becoming more popular as a means of achieving rapid hemostasis. CASE REPORT The patient is a 61-year-old woman who underwent a laparoscopic supracervical hysterectomy. FloSeal Hemostatic Matrix (Baxter Healthcare, Deerfield Illinois) was used at the conclusion of the procedure. RESULTS Pathology unexpectedly revealed high-grade leiomyosarcoma of the uterus. The patient then presented to our facility for consultation and was scheduled for robotic trachelectomy and lymphadenectomy. Laparoscopy revealed nodular lesions throughout the abdomen and pelvis. Biopsies were performed and the case aborted. Final pathology however showed caseating foreign body giant cell granulomata in all specimens. No malignancy was found. The patient then underwent exploratory laparotomy, trachelectomy, and a staging procedure. All pathology specimens and pelvic washings were negative for malignancy. CONCLUSIONS Use of gelatin-thrombin hemostatic agents may elicit a foreign body reaction leading to large giant cell granulomata. In this case, the presence of these granulomata mimicked metastatic disease.