腹腔内異物肉芽腫の１切除例の経験と画像診断の検討

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  • A Case of Retained Surgical Sponge (gossypiboma) and MR Features.

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The patient was a 66-year-old male who had undergone gastrectomy 24 years ago. He was admitted to our hospital with an abdominal mass, and physical examination revealed a painless movable lesion, 10 cm in diameter, in the right upper abdomen. CT and US demonstrated an abdominal tumor-like mass with inhomogeneous internal components. MR showed predominantly low-intensity signals admixed with high-intensity signals on T2-weighted images, and nonhomogeneous enhancement was evident following contrast administration. The lesion was suspected to be a retained surgical sponge (gossypiboma) and excised. The cut-surface showed irregular areas of fibrosis and a hematoma with an artificial gauze background, and histopathological examination revealed marked infiltration of foreign body giant cells and foamy cells as well as a histiocytic reaction. Identification of polarizable foreign material was consistent with the diagnosis of gossypiboma. The CT and MR scan features of gossypibomas are nonspecific. On CT, a whirl-like spongiform pattern is characteristic, but this feature dose not appear consistently in all cases. On T2-weighted MR images, gossypibomas show both low- and high-intensity signals, histologically reflected as granulomatous and fluid exudative changes, respectively. The findings on CT and MRI in our case seem to be compatible with the histopathological features. Thus, not only preoperative diagnosis, but also prediction of the histological features of gossypibomas seem possible by CT and MRI.

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