Multiple glove powder granulomas masquerading as peritoneal carcinomatosis.

BACKGROUND

The occurrence of glove powder granulomas in peritoneal nodules presumed to represent carcinomatosis has not gained widespread attention and remains a challenging clinical problem even for the experienced surgeon.

STUDY DESIGN

During the past four years, we have registered ten cases of multiple glove powder granulomas, believed by the surgeon to represent tumor dissemination, but diagnosed by the pathologist as glove powder granules with the typical Maltese cross pattern when viewed under polarized light.

RESULTS

Patients were referred with the presumptive diagnosis of intra-abdominal malignant disease and all had undergone at least one previous laparotomy during the past few years at a hospital that used powdered gloves. The unsuspected perioperative finding of multiple peritoneal nodules was presumed to represent carcinomatosis and resulted in the surgeon erroneously cancelling the operation in one case. In six other cases, the results of perioperative frozen sections caused the surgeon to change strategy and perform the planned procedure. Three patients had starch powder peritonitis postoperatively and one of them had a fatal pulmonary embolus. In two patients, the starch powder reaction was associated with the occurrence of true carcinomatosis and one patient later had recurrence of hepatic metastases. After a mean follow-up period of 17 months, six patients are alive with no signs of disseminated malignancy.

CONCLUSIONS

Based on this information, we recommend routine pathologic documentation of all peritoneal nodules appearing to be tumor dissemination. If the results influence the surgical procedure, frozen sections should always be performed. To minimize the risk of powder-induced complications, the use of particle-free gloves is strongly recommended.