A 73-year-old male presented with a three months. history of a painful enlarging mass in the anteromedial aspect of the mid-thigh. He recalled a fracture of the femur at the site of the mass 50-years earlier that had been treated by open reduction, immobilized for eight mos in a hip spica, healed uneventfully and caused no disability in the intervening years.
A: AP and lateral radiographs at presentation. There is a vague suggestion of a medial soft tissue mass adjacent to the healed, remodeled fracture site.
B: Oblique radiograph at presentation. The oblique view shows a modest superficial anterior cortical defect.
C: Axial CT image cut through the proximal portion of the mass. There is an isodense anterior soft tissue mass abutting the ancient healed fracture site and the anterior cortical defect.
D: Axial CT image cut through the distal portion of the mass.
A needle biopsy was consistent with chronic inflammation. Cultures of the tissue showed no growth. An open biopsy was followed by a marginal excision.
E: An intraoperative view of the biopsy site. The mass was composed of soft granulomatous vascular tissue.
F: The tissue obtained by marginal excision. The mass was removed piecemeal.
G: A field from the interior of the specimen. The field is composed of scattered chronic inflammatory cells, immature collagen, edema and in the upper left corner a foreign body giant cell. In the center of the field is a long slender slate grey fiber of foreign material.
H: Another field from the interior of the specimen. In the center of the field is a large foreign body giant cell. In it's cytoplasm is another fiber of foreign material.
I: A field from the interior of the lesion under polarized light. Polarized light brings out the multiple fibers of foreign matrial from a retained surgical sponge containing cotton fibers.
Diagnosis: Gossypiboma (derived from the Greek for cotton balloma) of foreign body reaction to cotton.
Treatment: Observaion. The wound healed per primum and the patient has been asypmtomatic for the following 2 yrs. A malpractice suit was entered against the surgeon (long since deceased) and his estate but summarily dismissed by the court.