機器人輔助根治性攝護腺切除術後黃體生成素釋放激素激動劑注射部位腹壁肉芽腫 – 案例報告

曾博鴻、陳俊吉

彰化基督教醫院 外科部 泌尿科

Granuloma of the abdominal wall at the luteinizing hormone-releasing hormone agonist injection site after robot-assisted radical prostatectomy – a case report

Po-Hung Tseng, Chun-Chi Chen

Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

Introduction

Granuloma of the abdominal wall refers to the formation of a localized, nodular mass or growth in the abdominal wall composed of granulation tissue. Granulation tissue consists of new blood vessels, fibroblasts, and inflammatory cells and is often associated with the healing process in response to injury, infection, or inflammation.

Herein we presented a case of granuloma of the luteinizing hormone-releasing hormone (LHRH) agonist injection site after robot-assisted radical prostatectomy.

Case report

A 72-year-old male with a history of prostatic adenocarcinoma, status post robot-assisted radical prostatectomy 2 years ago, underwent adjuvant androgen deprivation therapy (ADT) with leuprorelin acetate for 3 months postoperatively. During outpatient follow-up, a palpable mass was discovered at the injection site of leuprorelin acetate, raising suspicion of a metastatic nodule. Computed tomography revealed two subcutaneous masses on the right lower abdominal wall measuring about 4.6 cm and 3.6 cm. The PSA levels during follow-up remained below 0.01 ng/mL. The patient underwent excision of the abdominal wall tumor, and postoperative recovery was uneventful, with discharge next day. Pathological report of the excised tissue confirmed the diagnosis of a granuloma.

Conclusion

        While surgical intervention was undertaken due to the potential for malignancy, no evidence of malignancy was detected ultimately. It is important to note that LH-RH analogs may induce granulomas at the injection site resembling metastatic nodules. Therefore, patients receiving leuprorelin acetate should be informed about the possibility of injection-site granulomas. When patients present with subcutaneous nodules, it is imperative to confirm whether LH-RH analogs were administered at the nodular site or not.