Jakob Graves Rønk Dinesen, Katrine Fuglsang, Gitte Ørtoft Lykkegaard, Lone Kjeld Petersen and Margit Dueholm
We report a case where hemostatic fleece (TachoSil) was misinterpreted as residual disease on imaging after macro-radical surgery for ovarian cancer. Laparotomy was performed on a 51 year-old woman due to ovariancancer. At surgery, carcinomatosis was identified on the diaphragm with growth intothe diaphragmatic muscle. Total hysterectomy, bilateral salpingooophorectomy, omentectomy, pelvic and paraaortic lymphadenectomy, diaphragmatic peritonectomy, appendectomy and resection of sigmoid colon were performed. During surgery an incidental small liver lesion occurred and hemostatic fleece was applied for hemostasis. Total cytoreduction was achieved. The pathology report demonstrated stage IV serous ovarian cancer (grade III). The patient was therefore referred to the Department of oncology for six series of Paclitaxel/Carboplatin. A baseline CT scan revealed an area above the liver initially described as residual disease. At the multidisciplinary conference the CT scan was revised and compared with the surgical report and it was concluded that the suspected area concurred with the hemostatic fleece applied during surgery and not a sign of residual disease. After two months of adjuvant chemotherapy, a follow up CT scan revealed almost total regression and after six months, a MRI demonstrated almost no signs of the hemostatic fleece or recurrent disease. The patient is still disease free after18 months. Application of a hemostatic fleece may initiate inflammatory changes causing imaging artifacts. We, therefore, emphasize the importance of reporting in the operation note the specific location of hemostatic fleece applied during surgery to avoid hemostatic fleece being misinterpreted as residual disease on imaging.
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