title: Textiloma (gossypiboma) mimicking recurrent intracranial tumor.
abstract: BACKGROUND
  Resorbable substances used to achieve hemostasis during neurosurgical procedures comprise 3 principal classes based on chemical composition: (1) gelatin sponge, (2) oxidized cellulose, and (3) microfibrillar collagen. Nonresorbable hemostatic aides include various forms of cotton and rayon-based hemostats (cottonoids and kites). Resorbable and nonresorbable hemostatic agents have been reported to cause symptomatic mass lesions, most commonly following intra-abdominal surgery. Histologic examination typically shows a core of degenerating hemostatic agent surrounded by an inflammatory reaction. Each agent exhibits distinctive morphologic features that often permit specific identification. Hemostat-associated mass lesions have been variously referred to as textilomas, gossypibomas, gauzomas, or muslinomas.
  
  
  OBJECTIVE
  The aims of this study were to (1) identify cases of histologically proven cases of textiloma in neurosurgical operations, (2) characterize the specific hemostatic agent associated with textiloma formation, and (3) characterize the preoperative magnetic resonance imaging appearance of textiloma.
  
  
  METHODS
  Cases in which a textiloma constituted the sole finding on repeat surgery for recurrent brain tumor, or was a clinically significant component of a radiologically identified mass lesion together with residual tumor, constituted the study set.
  
  
  RESULTS
  Five textilomas were identified and evaluated. The primary neoplasm was different in each case and included pituitary adenoma, tanycytic ependymoma, anaplastic astrocytoma, gliosarcoma, and oligodendroglioma. In all cases, preoperative magnetic resonance imaging suggested recurrent tumor. Textilomas included all categories of resorbable hemostatic agent. Other foreign bodies were present in some cases; the origin of these foreign bodies was traced to fibers shed from nonresorbable hemostatic material placed temporarily during surgery and removed before closure (cottonoids and kites). Inflammatory reactions included giant cells, granulomas, and fibroblastic proliferation. Microfibrillar collagen (Avitene) textilomas were associated with a striking eosinophil infiltration that was not seen with any other hemostatic agent.
  
  
  CONCLUSIONS
  Hemostatic agents may produce clinically symptomatic, radiologically apparent mass lesions. When considering a mass lesion arising after intracranial surgery, the differential diagnosis should include textiloma along with recurrent tumor and radiation necrosis.
authors.affiliation: Department of Pathology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Suñer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ribalta
authors.forename: Ian E
authors.initials: IE
authors.lastname: McCutcheon
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Neto
authors.forename: Deepali
authors.initials: D
authors.lastname: Gupta
authors.forename: A J
authors.initials: AJ
authors.lastname: Kumar
authors.forename: David A
authors.initials: DA
authors.lastname: Biddle
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Langford
authors.forename: Janet M
authors.initials: JM
authors.lastname: Bruner
authors.forename: Norman E
authors.initials: NE
authors.lastname: Leeds
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Fuller
mesh_terms: D000293:Adolescent; D000328:Adult; D001927:Brain Diseases / Q000175:diagnosis* / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis*; D002483:Cellulose, Oxidized; D003094:Collagen; D032561:Cotton Fiber; D003937:Diagnosis, Differential; D005260:Female; D005781:Gelatin Sponge, Absorbable; D015745:Granuloma, Foreign-Body / Q000175:diagnosis* / Q000473:pathology; D006104:Granuloma, Plasma Cell / Q000175:diagnosis* / Q000473:pathology; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006490:Hemostatics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D011832:Radiation Injuries / Q000175:diagnosis
chemical_list: D002483:Cellulose, Oxidized; D006490:Hemostatics; C013695:Surgicel; D003094:Collagen