Cotton-induced pseudotumor of the femur

Abstract

Twenty-five years prior to presentation a 41-year-old man had a femoral fracture stabilized with a 4.5 mm AO/ASIF steel plate. The femur healed uneventfully and the patient was asymptomatic for the following 20 years. He then noticed a slow-growing swelling of the left thigh associated with a degree of weakness. Radiographs of the femur 25 years after fracture stabilization showed a massive expansive osteolytic process surrounded by a rim of bone. Magnetic resonance imaging (MRI) confirmed the presence of a large tumor. Since malignancy could not be excluded the patient underwent incisional biopsy. The histologic findings were nonspecific. Because of persistent symptoms the lesion was marginally excised. Intraoperatively a folded cotton sponge was found adjacent to the femur. Histopathologic investigation confirmed a foreign body reaction probably related to the retained cotton sponge. Reactive, foreign-body-induced change may mimic bone and or soft tissue malignancies.

Distal biceps brachii tendon repair complicated by a suture granuloma mimicking a soft-tissue sarcoma: a case report and review of the literature

“…14 The incidence of foreign-body granulomas after orthopaedic surgeries has been described to be 0.61%, and these have been reported as isolated cases. 1,2,9,10,[13][14][15][16][17][18][19]23,27 Few articles have reported on suture foreign-body granulomas in the orthopaedic literature (Tables I and II). [14][15][16]18,27 Morimoto et al 16 reported a 2-year history of a left buttock mass that rapidly grew over a period of 2 months after nonabsorbable nylon suture was used to surgically repair a hip dislocation 20 years earlier.…”

“…14 In most of the cases in which outcomes were reported, the patients did well (Tables I and II). 10,[13][14][15][16]23,27 STSs are uncommon malignancies, with approximately 50% of the cases located in the extremities. 24 A slowly growing mass warrants high suspicion for this diagnosis, particularly for masses larger than 5 cm, those located deep to the deep fascia, and those associated with rapid growth, progressive symptoms of pain, or ulceration.…”

Biologic response of local hemostatic agents used in endodontic microsurgery

“…However, because it is not bio-resorbable, the remaining cotton fiber has been suggested as a factor that causes inflammation and healing retardation 16. Several case reports are warning the undesirable tissue reaction induced by cotton remnants 76,77. Sexton et al reported intensive foreign body reaction from a remaining cottons sponge, which developed a large soft tissue mass in femur, and termed the mass as 'cottonballoma' 77.…”

Foreign-body granulomas in the trunk and extremities may simulate malignant soft-tissue tumors: report of three cases

“…Acta Radiol 2008 (1) gradually with degeneration in the human body, the findings on MR images are diverse. Preoperatively, all three cases were diagnosed as having a malignant soft-tissue tumor, based on the following MRI findings: a) tumor located deep in the soft tissues, b) tumor over 10 cm in maximum diameter with a well-defined margin and round or ovoid in shape, c) homogeneous iso-signal intensity on T1WI and heterogeneous high signal intensity on T2WI, d) enhancement of the central area of the tumor following gadolinium-containing contrast medium administration, and e) presence of marginal edema around the lesions.…”