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a gossypiboma , also called textiloma , literally means retained surgical sponge and is derived from the latin word " gossypium , " which means " cotton , " and " boma " in kiswahili , which means " place of concealment . "
it is difficult to diagnose a gossypiboma in the neck because of its rarity , various symptoms , and non - specific radiologic findings .
furthermore , it can be misinterpreted as malignancy and finally diagnosed from a histopathological examination of the surgical specimen after unwarranted radical surgery . to our knowledge , a gossypiboma following head and neck operations
we present a case of a gossypiboma presenting neck mass mimicking an isolated neck recurrence with a patient who had underwent thyroidectomy with a neck dissection for papillary thyroid carcinoma at a local hospital .
this report may help clinicians reduce the likelihood of misdiagnosis and avoid unnecessary radical operation .
a 53-year - old woman was referred to our head and neck cancer clinic for an asymptomatic neck mass in the left supraclavicular area growing over the past 2 months .
she had a history of a total thyroidectomy with a left lateral neck dissection for papillary thyroid cancer at another hospital 6 months prior .
a physical examination revealed a neck mass approximately 34 cm in size on the same side of previous neck dissection . computed tomography showed the inhomogeneous , low - density mass with an enhanced surrounding capsule ( fig .
1a ) . positron emission tomography / computed tomography ( pet / ct ) demonstrated the rim - shaped fluorodeoxyglucose ( fdg ) uptake with the central nidus without fdg uptake ( fig .
however , we considered it as a neck recurrence following previous neck dissection and thus planned to perform a salvage modified radical neck dissection .
a well - encapsulated hard mass was noted between the common carotid artery and internal jugular vein .
it was displacing the carotid artery to the posterior - medial side and adherent to the internal jugular vein .
gross appearance of the resected specimen revealed a fibrotic mass lesion containing a surgical sponge ( fig .
a microscopic examination revealed foreign body reaction and fibrosis surrounding the surgical sponge ( fig .
a gossypiboma has still been observed in clinical practice in spite of an increase of use of radio - opaque swabs and caution given by surgical teams .
gawande et al .   reported that the significant factors associated with a high risk of retention of a foreign body during surgery included emergency surgery , an unplanned change in surgical procedure , and body - mass index .
intraabdominal or intrathoracic gossypiboma are relatively more common , but gossypiboma in the neck is extremely rare because its surgical field is not as wide and deep as the abdomen .
the acute presentation typically consists of local inflammatory reaction such as an abscess formation with or without secondary bacterial infection . however , gossypiboma may develop months or even years after the initial surgery as a delayed presentation .
it would have resulted from an aseptic foreign body reaction to the cotton materials and surrounding fibrotic encapsulation and adhesion .
gossypiboma demonstrates various radiological manifestations , and even can change in its appearance depending on the location and the type of foreign body reaction .
a characteristic sonographic finding of gossypiboma includes a highly echogenic curvilinear structure with dense posterior acoustic shadowing .
the typical radiologic finding on computed tomography is a predominantly high attenuation central mass with a spongiform pattern of air bubble and a hyperdenese , well - enhancing rim .
the characteristic magnetic resonance imaging features include the delineation of a well - defined mass with a peripheral wall of low signal intensity at t1- and t2-weighted imaging , with whorled stripes within the internal portion and peripheral wall enhancement at contrast - enhanced t1-wighted imaging . regarding the features of fdg pet of gossypibomas recently reported , gossypiboma showed a circular rim - shaped fdg uptake indicating the fibrous encapsulation and a central nidus without fdg uptake representing the cavity packed with blood clots and the retained sponge .
multidisciplinary approaches and new technologies such as a bar - code system and radiofrequency identification may help to reduce these events .
however , the most important factor for preventing these events is the exact counting of sponges . during operations , all surgeons and assistants should check for retained surgical gauzes and count the number of gauzes used . with those efforts of regular
counting of all instruments , and use of radio - opaque swabs , this avoidable error should be completely eradicated .
it is essential for clinicians to be aware of this disease entity in differential diagnosis of neck recurrence because a gossypiboma in the neck can be misinterpreted as a malignancy to induce unwarranted radical surgery .
a gossypiboma ( also called textiloma or retained surgical sponge ) of the neck is rarely reported compared to intraabdominal or intrathoracic gossypibomas and also can be misdiagnosed as metastatic lymph nodes . 
 a patient was referred to our clinic for a supraclavicular neck mass 6 months after thyroidectomy and neck dissection for papillary thyroid carcinoma in another hospital . 
 it was initially considered an isolated neck recurrence , but it was finally diagnosed as gossypiboma by a pathological examination of the surgically - excised specimen . 
 characteristic findings of computed tomography or positron emission tomography / computed tomography might be helpful to differentiate the gossypiboma from malignant neck mass or other inflammatory conditions . 
 it is essential for clinicians to be aware of this disease entity in differential diagnosis of neck recurrence because a gossypiboma in the neck can be misinterpreted as a malignancy to induce unwarranted radical surgery .