PMC5080713_01
a Transabdominal ultrasound. b Transvaginal ultrasound shows the suspected tumor in the lower abdomen, measuring about 5.5 x 5.7 x 9.4 cm. The cyst has a solid as well as fluid content and an anechoic area behind the cyst. The bladder is not involved
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Fig1
Our transvaginal and transabdominal ultrasound investigation revealed a cystic lesion measuring 9.4 cm x 5.7 cm in this area (Fig. 1).
Laparoscopic view of the patient's lower abdomen. a + b Tumor mass between the uterus and the bladder. Both ovaries are free of suspected lesions. c The cyst was opened to remove the infectious fluid and revealed a solid foreign mass. The surgical sponge is removed laparoscopically. d The surgical site after complete removal of the sponge. The intact bladder is seen in the deeper aspect, after retrograde blue dye filling. The complete capsule of the tumor was removed and bleeding was observed in the wound bed
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Fig2
In accordance with clinical findings, the operation site showed a swelling between the uterus and the bladder (Fig. 2). We decided to remove the tumor by laparoscopy, which then turned out to be a retained surgical sponge with granulation tissue (Fig. 2).
Histological work-up of the retrieved material (scale 400 mum). In addition to vascularized fat and connective tissue we found (a) dense fibroblast proliferation with extensive macrophage clusters and multinuclear giant cells (box), which have phagocytosed filiform foreign matter that turns birefringent in polarized light (b)
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Fig3