CASE 4018 Published on 13.08.2005

GOSSYPIBOMA PRESENTING AS A RENAL MASS: A CASE REPORT

Section

Uroradiology & genital male imaging

Case Type

Clinical Cases

Authors

Filip Van Kerkhove1, Kenneth Coenegrachts1, Charlotte Gabriel2, Kris Van De Moortele1, Jan Walther Casselman1 1. Department of Radiology, AZ St.-Jan AV, Ruddershove 10 - 8000 Bruges, Belgium. 2. Department of Pathology, AZ St.-Jan AV, Ruddershove 10 - 8000 Bruges, Belgium

Patient

69 years, female

Clinical History
A 69-year-old lady was admitted to our hospital with ferriprive anemia. A pyelotomy was performed 9 years ago. An aspecific renal mass with linear calcifications and a tumoral mass in the ascending colon were depicted. The patient was operated on and histologic examination of both masses was obtained.
Imaging Findings
A 69-year-old lady was admitted to our hospital with ferriprive anemia. A pyelotomy was performed 9 years ago for urolithiasis in the left renal pyelum. A gastroduodenal enteroscopy and a coloscopy were performed and no clinically significant pathology was found. A MultiSlice Computed Tomography (MSCT) scan (Lightspeed 16, General Electric, Milwaukee, USA) of the abdomen was performed. An aspecific tumoral mass in the upper pole of the left kidney and a tumoral mass in the ascending colon were depicted. For further differentiation of the renal mass, a MSCT of the kidneys was planned. The kidneys were scanned before (Fig.1) and in the arterial (Fig.2) and venous (Fig.3) phase after administration of intravenous contrast agent (Xenetix 300, Guerbet, France). The MSCT images demonstrated a tumoral mass of approximately 7 cm diameter, with linear calcifications and discrete enhancement of the peripheral rim in the venous phase only. This discrete contrast enhancement was only detectable by measuring the Houncefield Units on the scanner console. Coronal (Fig.4) and sagittal (Fig.5) reformations were made to better visualize the border between the kidney and the detected mass. A new coloscopy confirmed an ulcerative neoplastic process in the ascending colon. The treating surgeon and urologist planned a combined right hemicolectomy and a left nefrectomy. Histologic examination of the colonic mass and of the renal mass (Fig.6) was performed.
Discussion
There are numerous case reports of retained foreign bodies in the literature. The reported incidence varies between 1 per 1000 to 1 per 10000 foreign bodies.(1) The true incidence is thought to be underreported secondary to the possible legal ramifications of this technical oversight. The term gossypiboma is derived from the latin word of ‘gossypium’, meaning cotton and the Kiswahili word ‘boma’, meaning place of concealment. Gossypiboma refers to a granulomatous reaction caused by a surgical sponge or textilloma, unwillingly left in a surgical wound. Most surgical sponges are made of cotton and although cotton is inert, it may stimulate a granulomatous reaction or lead to secondary infection with subsequent abscess and fistula formation, peritonitis, septicaemia, bowel obstruction or even hemorrhage. Acute presentations generally follow a septic course with abscess and/or granulomatous formation. Delayed presentation may follow months or years after original surgery, with adhesion formation and encapsulation. The patients who present after a longer period of time have a typical fibrinous reaction surrounding the gossypiboma. There may be atypical calcifications present and a thick irregular inflammatory wall.(2,3) The abdominal cavity is the most common site of reported gossypiboma, although many other sites have been described: pararenal, nose, breast, tracheobronchial tree, vagina, spine, femur, neck, prostate. Although certain characteristic plain-film, CT, ultrasound and even magnetic resonance features of gossypiboma have been described, the appearance of retained sponges may be variable with any imaging technique, and the diagnosis can be especially difficult if a radiopaque marker is not present.(4,5) The reported CT appearances of gossypiboma are often not pathognomonic and most of the times nonspecific. Gossypiboma can present as a sharply defined rounded mass with a dense central part and an enhancing wall with or without gas bubbles. The differential diagnosis of a gossypiboma with an organized hematoma or a tumoral proces (benign or malignant) can be very challenging. Prevention of gossypiboma is of great importance. Most reported cases of gossypibomas occur in the presence of a normal pack count. Additional counts are recommended to avoid not only the medical, but also the legal complications due to a gossypiboma. Although gossypiboma is rarely seen it can be found after any kind (gynaecological, thoracic, abdominal, head and neck, musculoskeletal, cranial) of surgical intervention and it should be included in the differential diagnosis of an atypical presentation of a tumoral mass, organised hematoma or abscess.
Differential Diagnosis List
GOSSYPIBOMA
Final Diagnosis
GOSSYPIBOMA
Case information
URL: https://www.eurorad.org/case/4018
DOI: 10.1594/EURORAD/CASE.4018
ISSN: 1563-4086

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