Histopathology Artifacts Quiz
ANSWER CASE 4
This section shows a starch granuloma. Starch is used as a powder in
surgical gloves and can therefore contaminate body tissues during an
operation. Over a period of time a granulomatous reaction occurs
around the starch which may not necessarily cause the patient any
inconvenience but may cause the pathologist a few problems in trying
to identify the cause of the granulomatous reaction. Starch
contamination can also occur after the specimen reaches the
laboratory, during cut-up but of course in that situation there is
not a granulomatous reaction. Starch granules can be difficult to
see in sections under normal brightfield microscopy. They tend to be
spherical to slightly angular (hexagonal), very pale in H&E and some
will exhibit a small central dark spot. They do stain very strongly
with the Periodic Acid Schiff (PAS) reaction but are most easily
seen under polarised light when they show a characteristic "Maltese
cross" birefringence. Give yourself a mark if your answer is starch
granuloma or glove powder contamination.

© Roy C. Ellis 2004