MULTIPLE GLOVE POWDER GRANULOMAS MASQUERADING AS PERITONEAL CARCINOMATOSIS

BACKGROUND: The occurrence of glove powder granulomas in peritoneal no dules presumed to represent carcinomatosis has not gained widespread a ttention and remains a challenging clinical problem even for the exper ienced surgeon. STUDY DESIGN: During the past four years, we have regi stered ten cases of multiple glove powder granulomas, believed by the surgeon to represent tumor dissemination, but diagnosed by the patholo gist as glove powder granules with the typical Maltese cross pattern w hen viewed under polarized light. RESULTS: Patients were referred with the presumptive diagnosis of intra-abdominal malignant disease and al l had undergone at least one previous laparotomy during the past few y ears at a hospital that used powdered gloves. The unsuspected perioper ative finding of multiple peritoneal nodules was presumed to represent carcinomatosis and resulted in the surgeon erroneously canceling the operation in one case. In six other cases, the results of perioperativ e frozen sections caused the surgeon to change strategy and perform th e planned procedure. Three patients had starch powder peritonitis post operatively and one of them had a fatal pulmonary embolus. In two pati ents, the starch powder reaction was associated with the occurrence of true carcinomatosis and one patient later had recurrence of hepatic m etastases. After a mean follow-up period of 17 months, six patients ar e alive with no signs of disseminated malignancy. CONCLUSIONS: Based o n this information, we recommend routine pathologic documentation of a ll peritoneal nodules appearing to be tumor dissemination. If the resu lts 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.