Starch artifacts in oral cytologic specimens

Maltese cross: Starch artifact in oral cytology, divulged through polarized microscopy

“…Starch powder, a lubricant of surgical gloves, is well recognized as a common contaminant of cytological and histological specimens. [1]…”

“…Starch powder is a well-documented iatrogenic cause for granulomatous lesions, both extraorally and intraorally. [1] In such situations, severe foreign body reactions may be seen, like starch granulomas. On the other hand, accidental starch granule contamination of biopsy tissues may occur during surgical removal or during specimen processing in the laboratory.…”

“…[1] Moreover, Lovas et al . [1] have cited that these bodies might resemble epithelial cells. With scanning electron microscopy, starch granules appear as spherical, faceted balls, which can vary from 2.5 to 30 micrometer in diameter.…”

“…With scanning electron microscopy, starch granules appear as spherical, faceted balls, which can vary from 2.5 to 30 micrometer in diameter. [1] The same with scanning electron microscopy varied from 5 to 20 micrometer in diameter. [3] The Maltese cross under polarized light is characteristic, but not specific, for starch and can also be seen with some inorganic particles.…”

Oral biopsy: Oral pathologist′s perspective

“…Cotton in the section can mimic amyloid-like substance, and presence of glove starch leads to starch artifacts that can appear as atypical epithelial cells in histopathological sections. [23,24] If it is a hard tissue lesion, it is important to take a radiograph of the specimen so that it might also help in assessing whether the lesion is been removed to its entirety.…”