Bilateral Scrotal MASSES in an Infant: Remote Presentation of an Inflammatory Reaction to Surgical Glove Powder

Foreign body reactions can be induced following abdominal surgery, resulting in adhesions and subsequent intestinal obstruction. Foreign materials such as glove powder, lint from surgical packs and sutures have been implicated as causative agents in addition to infection, intraoperative tissue damage or ischemia and spillage of organ contents. 1 We report on a 2-month-old male with bilateral scrotal masses resulting from a foreign body reaction to cornstarch surgical glove debris. CASE REPORT A 58-day-old male presented with bilateral scrotal masses 1 day in duration. The appearance of the masses was preceded by nonspecific irritability several days in duration. There was no history of vomiting, diarrhea, fever or change in feeding habits. Medical history was remarkable for pyloric stenosis requiring a pyloromyotomy. Physical examination demonstrated bilateral firm scrotal masses separate from the testes. These masses did not transilluminate and could not be reduced despite their mobility. The scrotal skin had lost its rugae and was erythematous. Urinalysis was normal. On scrotal ultrasound the masses were interpreted to represent marked bilateral epididymal enlargement with increased vascularity (fig. 1). Both testes were normal in size and surrounded by small hydroceles. Because of the uncertainty raised by the bilateral nature of the masses and associated inflammatory process, inguinal exploration was undertaken. A patent processus vaginalis and a distinct paratesticular mass were identified on the left side, and frozen section analysis was consistent with fibrous tissue and perivascular chronic inflammation. The mass was removed and the inguinal hernia was repaired. Although exploration of the right side did not reveal the presence of a hernia, a similar paratesticular mass was found. Final pathological diagnosis was foreign body reaction. No neoplasia was identified. Many of the giant cells in the pathological specimen contained foreign birefringent material that was irregular in outline and ranged in size from 3 to 20 . Under polarized microscopy this material had a Maltese cross configuration and stained strongly positive with periodic acid-Schiff and Giemsa (fig. 2). The surrounding proliferative fibroblastic tissue contained scattered collections of histiocytes forming foreign body giant cells admixed with