Aim: To give perspective on suture granuloma in oral biopsy specimens. Background: Suture granuloma is an uncommon finding in the oral biopsy specimens. Suture granulomas may give the impression of both benign and malignant lesions, thus posing a serious diagnostic challenge. Hence, it is very important that oral pathologists should understand pathogenesis and histopathology of this rare phenomenon. Results: Suture granuloma evokes immunological reaction with recruitment of monocyte macrophages, which ultimately forms epithelioid cells and giant cells. The pathogenetic events were driven by the factors such as interleukins, MHC class II molecules, CD4+ Th1 lymphocytes, transforming and platelet derived growth factors. Histopathologically, they are easy to identify due to characteristic appearance of granuloma surrounding the suture material. Conclusion: This paper presents a very rare occurrence of suture granuloma in an oral biopsy specimen with special emphasis on pathogenesis and histopathology. Clinical relevance: Accidental findings in oral pathologies are not very common evidence. Suture granuloma is one such phenomenon that can be mistaken for benign or malignant neoplasm. Hence, it becomes of paramount importance to realize the need of understanding this phenomenon for oral pathologists to avoid diagnostic confusion. This short communication elaborates the histomorphological appearance of suture granuloma, which will help pathologists in accurate diagnosis and hence management.
James DG. A clinicopathological classification of granulomatous disorders. Postgrad Med J 2000;76(898):457–465. DOI: 10.1136/pmj.76.898.457.
Lynch TH, Waymont B, Beacock CJ, et al. Paravesical suture granuloma: a problem following herniorrhaphy. J Urol 1992;147(2):460–462. DOI: 10.1016/s0022-5347(17)37273-7.
Yoshioka Y, Nakatao H, Hamana T, et al. Suture granulomas developing after the treatment of oral squamous cell carcinoma. Int J Surg Case Rep 2018;50:68–71. DOI: 10.1016/j.ijscr.2018.07.021.
Molina-Ruiz AM, Requena L. Foreign body granulomas. Dermatol Clin 2015;33(3):497–523. DOI: 10.1016/j.det.2015.03.014.
Secil M, Mungan U, Yorukoglu K. Suture granuloma after orchiectomy: sonography, doppler and elastography features. Int Braz J Urol 2015;41(4):813–816. DOI: 10.1590/S1677-5538.IBJU.2013.0207.
Mathai AM, Preetha K, Valsala Devi S, et al. Post-thyroidectomy suture granuloma: a diagnosis on fine needle aspiration cytology. Diagn Cytopathol 2018;46(9):756–759. DOI: 10.1002/dc.23942.
Alkan S, Akdeniz R, Sungur M, et al. Silk suture granuloma after high orchiectomy. Urologiia (Moscow, Russia: 1999) 2020(6):113.
James DG. What makes granulomas tick? Thorax 1991;46(10):734–736. DOI: 10.1136/thx.46.10.734.
James DG. Granuloma formation signifies a Th1 cell profile. Sarcoidosis 1995;12(2):95–97.
Roman J, Jeon YJ, Gal A, et al. Distribution of extracellular matrices, matrix receptors, and transforming growth factor-beta 1 in human and experimental lung granulomatous inflammation. Am J Med Sci 1995;309(3):124–133. DOI: 10.1097/00000441-199503000-00002.
Aga H, Hirokawa M, Suzuki A, et al. Sonographic evaluation of nodules newly detected in the neck after thyroidectomy: suture granuloma versus recurrent carcinoma. Ultrasound Int Open 2018;4(04):124–130. DOI: 10.1055/a-0749-8688.
Mathew AA, Kowal L. Conjunctival granuloma post pulley fixation suture. J AAPOS 2017;21(4):342–343. DOI: 10.1016/j.jaapos.2017.03.012.
Sarode GS, Sarode SC. Superficial mucoceles at surgical mucosal margins of excised oral cancer specimens: an unexpected finding. Oral Oncol 2016;56:e1–e2. DOI: 10.1016/j.oraloncology.2015.12.009.
Shinohara T, Kashiwagi H, Nakada K, et al. Suture line recurrence in the jejunal pouch after curative proximal gastrectomy for gastric cancer: report of two cases. Hepato-gastroenterology 2007;54(78):1902–1904.
Dehni N, Caplin S, Frileux P, et al. Cancer recurrence along the pouch longitudinal suture line after colonic J pouch-anal anastomosis. Br J Surg 2002;89(2):206–207. DOI: 10.1046/j.1365-2168.2002.01992.x.
Hsu TC, Chen MJ. Presence of colon carcinoma cells at the resection line may cause recurrence following stapling anastomosis. Asian J Surg 2018;41(6):569–572. DOI: 10.1016/j.asjsur.2018.01.006.
Leinhardt DJ, Smart PJ, Howat JM. Jejunal carcinoma associated with non-absorbable suture material. Postgrad Med J 1988;64(755): 716–717. DOI: 10.1136/pgmj.64.755.716.
Sarode SC, Sarode GS, Patil S. Suture line recurrence and oral squamous cell carcinoma: a viewpoint. Oral Oncol 2020. 104633. DOI: 10.1016/j.oraloncology.2020.104633.