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Paper text:
a 49-year - old woman was admitted with sign of acute onset tonic clonic grand mal epilepsy and seizure .
she had a throbbing frontal headache resistant to analgesics and intractable vomiting and blurred vision since three months ago . also , she had a positive medical history of craniotomy for removing brain tumor when she was 30 years old .
the complaint of the patient 19 years ago was also epilepsy , which was relieved by operation and anticonvulsant therapy ( carbamazepin , 200 mg , tds ) for 11 years .
only the report of first ct scan was accessible , which said :  a right frontal neopalastic tumofaction with severe peri lesion edema . 
a 56 cm round radio dense mass lesion in anterior interhemispheric arising from the falx was seen .
at the site of previous craniotomy a surgical defect in the right temporal bone and adjacent right frontal lobe encephalomalacia was seen ( figure 1 ) . a 56 cm round radio dense mass lesion in anterior interhemispher after a bicoronal incision at the previous site , a craniotomy was done by removing the right frontal bone .
after opening the dura matter , sub frontal and interhemispheric dissection anteriorly revealed the mass originating from falx cerebri which extended laterally in to the right frontal lobe and was tough , fibrous and beige in color .
the capsule of the mass was opened and yellowish cotton wool and creamy soft tissue was removed without complication .
after operation anti convulsant therapy continued and the patient was discharged with good condition and without any symptoms . her headache and seizure were resolved .
gross examination of the received specimen showed fragments of gray - white firm tissue measuring 213 cm , totally ( figure 2 ) .
the gross view of intracranial foreign body microscopic examination of the several h&e stained slides showed hyalininized tissue containing several foreign body granulomas ( figure 3 ) .
microscopic view of the intracranial foreign body polarizing microscope revealed refractile material gauze fibers ( figure 4 ) .
a 56 cm round radio dense mass lesion in anterior interhemispheric arising from the falx was seen .
punctuate hyper dense area due to calcium deposition was also noted . at the site of previous craniotomy a surgical defect in the right temporal bone and adjacent right frontal lobe encephalomalacia was seen ( figure 1 ) . a 56 cm round radio dense mass lesion in anterior interhemispher after a bicoronal incision at the previous site , a craniotomy was done by removing the right frontal bone .
after opening the dura matter , sub frontal and interhemispheric dissection anteriorly revealed the mass originating from falx cerebri which extended laterally in to the right frontal lobe and was tough , fibrous and beige in color .
the capsule of the mass was opened and yellowish cotton wool and creamy soft tissue was removed without complication .
after operation anti convulsant therapy continued and the patient was discharged with good condition and without any symptoms . her headache and seizure were resolved .
gross examination of the received specimen showed fragments of gray - white firm tissue measuring 213 cm , totally ( figure 2 ) .
the gross view of intracranial foreign body microscopic examination of the several h&e stained slides showed hyalininized tissue containing several foreign body granulomas ( figure 3 ) .
microscopic view of the intracranial foreign body polarizing microscope revealed refractile material gauze fibers ( figure 4 ) .
a 56 cm round radio dense mass lesion in anterior interhemispheric arising from the falx was seen .
punctuate hyper dense area due to calcium deposition was also noted . at the site of previous craniotomy a surgical defect in the right temporal bone and adjacent right frontal lobe encephalomalacia was seen ( figure 1 ) . a 56 cm round radio dense mass lesion in anterior interhemispher after a bicoronal incision at the previous site , a craniotomy was done by removing the right frontal bone .
after opening the dura matter , sub frontal and interhemispheric dissection anteriorly revealed the mass originating from falx cerebri which extended laterally in to the right frontal lobe and was tough , fibrous and beige in color .
the capsule of the mass was opened and yellowish cotton wool and creamy soft tissue was removed without complication .
after operation anti convulsant therapy continued and the patient was discharged with good condition and without any symptoms . her headache and seizure were resolved .
gross examination of the received specimen showed fragments of gray - white firm tissue measuring 213 cm , totally ( figure 2 ) .
the gross view of intracranial foreign body microscopic examination of the several h&e stained slides showed hyalininized tissue containing several foreign body granulomas ( figure 3 ) .
microscopic view of the intracranial foreign body polarizing microscope revealed refractile material gauze fibers ( figure 4 ) .
clinical symptoms caused by foreign body granulomas can be noticed from months to many years after surgical procedure .
suture material is the most common etiology of granulomas in noncentral nervous system surgery ; and various symptoms depending on deposited location can be seen .
they can simulate neoplasm clinically , radiologically , and even grossly.56 two cases reported by leong et al , illustrate the difficulty of detecting an unsuspected foreign body in mri .
when the signal characteristics and morphology may appear conflicting or uncertain on mri , consideration can be given to the use of ct , which is more sensitive to the presence of hemorrhage , gas , calcium or manmade material .
while a foreign body may be overlooked or difficult to demonstrate on mri , addition of ct , ultrasound or plain x - ray may provide a useful adjunct to diagnosis.7 searching published papers from 1965 to 2001 with keywords  foreign body granuloma  and  brain ,  20 such reports were found .
cotton materials used commonly for homeostasis during various operations may cause a foreign body granulomatous reaction that may resemble recurrent or progressive neoplasm or abscess .
when suspecting a central nervous system mass lesion as primary or recurrent , a second look laparatomy should be planned to determine the true nature .
the final treatment decisions depend on the nature of the mass lesion . in case of tumor recurrence , surgical resection and additional oncologic consultation should be recommended ; if the resection yields a foreign body reaction , potentially harmful therapy can be withheld or postponed.9 although rare , differential diagnosis of foreign body granuloma is stressed to pay attention not to leave cotton pledgets during operations.10
hs carried out the experiment , analyses , interpretation , and presentation and wrote the paper .
tf planned the project and assisted in analyses , interpretation , and presentation and edited the manuscript .
intracranial foreign body granulomas are rarely reported . 
 clinical symptoms caused by foreign body granulomas can be noticed from months to many years after surgical procedure . 
 the most common reported etiology is suture material . 
 a 45-year - old woman was presented with grand mal epilepsy . 
 she was operated for brain tumor 19 years ago . in ct scan 
 , a round radio - dense mass resembling a tumor at anterior fossa was seen . 
 she underwent craniotomy and resected a granuloma with cotton fibers surrounded by yellow capsule without residual or recurrent tumor . 
 granuloma can mimic intracranial meningioma and special attention should be paid not to leave cotton pledgets during operations .