The varied appearances of starch particles in smears and paraffin sections

Abstract

The varied appearances of starch particles in smears and paraffin sectionsEvidence is presented to show that maize starch particles, usually recognized in histological sections by their Maltese cross birefringence under cross-polarized light, lose this characteristic appearance when transected by the microtome blade. Such particles are, therefore, likely to be overlooked. Though maize starch usually enters the abdomen during surgery, the female genital tract is another possible route from sources such as contraceptive devices. Other types of starch particle have different shapes, sizes and surface markings and these may be distinguished from maize starch by light and electron optical methods.

Analogies in medicine: the rare paradigm of the Maltese (White) Cross

“…Talc powder or starch granulomatosis can develop in the peritoneum, representing a tissue reaction to foreign substances. Retained sponges after surgery, material contained in contraceptive devices and implanted in the peritoneum through the fallopian tubes or bowel perforation are other causes of peritoneum granulomatosis, more often seen in obese patients 2–4 . Talc/starch granulomatosis has also been reported in peripheral lymph node and myocardium 5 .…”

“…Retained sponges after surgery, material contained in contraceptive devices and implanted in the peritoneum through the fallopian tubes or bowel perforation are other causes of peritoneum granulomatosis, more often seen in obese patients. [2][3][4] Talc/starch granulomatosis has also been reported in peripheral lymph node and myocardium. 5 Differential diagnosis includes tuberculosis, Crohn's disease and disseminated metastatic carcinoma to the peritoneum.…”

“…Levison supported the fact that only corn starch may contribute to Maltese Cross formation, whereas other types of starch may produce other types of shape, size and surface markings. 2 Fortunately, peritoneal granulomatosis because of talc/starch powder is self-limited, without need for any specific treatment.…”