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Multiple glove powder granulomas masquerading as peritoneal carcinomatosis
K E Giercksky1, H Qvist, T C Giercksky
1Department of Surgical Oncology, Norwegian Radium Hospital, Oslo.
Journal of the American College of Surgeons
|September 1, 1994
Summary
Glove powder granulomas can mimic carcinomatosis, leading to misdiagnosis. Pathologic examination and use of particle-free gloves are crucial to avoid complications and ensure accurate surgical decisions.
Area of Science:
- Surgical Pathology
- Gastrointestinal Surgery
Background:
- Glove powder granulomas presenting as peritoneal nodules are often misdiagnosed as carcinomatosis.
- This diagnostic challenge can perplex even experienced surgeons.
Purpose of the Study:
- To highlight the occurrence and diagnostic challenges of glove powder granulomas.
- To emphasize the importance of accurate pathological diagnosis in suspected intra-abdominal malignancy.
Main Methods:
- Retrospective review of ten cases over four years.
- Pathological analysis of peritoneal nodules using polarized light microscopy to identify glove powder granules (Maltese cross pattern).
Main Results:
- Patients with glove powder granulomas were initially suspected of having intra-abdominal malignant disease.
- Misdiagnosis led to cancelled surgery in one case and altered surgical plans in six others.
- Complications included starch powder peritonitis and one fatal pulmonary embolus.
- Two cases with starch powder reaction were also associated with true carcinomatosis.
Conclusions:
- Routine pathological documentation of peritoneal nodules is recommended to differentiate from tumor dissemination.
- Frozen sections are vital when findings may influence surgical procedures.
- Adoption of particle-free gloves is advised to minimize powder-related complications.