Tuberculoid cornstarch granulomas with caseous necrosis. A diagnostic challenge

We studied a patient in whom peritoneal granulomas developed with caseous-type necrosis after exposure to cornstarch from surgical gloves. This necrotizing type of lesion, which is the least common among cornstarch granulomas, can simulate tuberculous infection and lead to initiation of antituberculous therapy. A review of the literature suggests that there are two basic types of cornstarch granulomas: the phagocytic, foreign body type, and the tuberculoid granuloma with and without central necrosis. The morphologic features and possible mechanism of formation of these types of granulomas are being discussed. Although the cornstarch particles can be identified with a variety of stains, the most reliable method is that of examination with polarized light, which is recommended in all cases of granulomas, especially abdominal ones.