Gouty Tophus

http://www.histopathology-india.net/SoftTissuePath.htm

Path Quiz Case- 57

Dr Sampurna Roy MD

Case history and images:

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Dr Sampurna Roy MD

http://www.histopathology-india.net/ dermpath.htm

Januay 2008

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Normal Histology of Skin
Glossary

Gross examination of the skin specimen

Reporting of biopsies taken for Inflammatory Skin Diseases

Lichenoid (Interface)Tissue Reaction Pattern

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Classification of Soft Tissue Tumour
Gross examination of soft tissue specimen
A practical approach to histopathological reporting of soft tissue tumours
Grading of soft tissue tumours
Lipomatous tumours
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Soft TissueTumours of Uncertain Differentiation
Notochordal Tumour - Chordoma
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Gastrointestinal Stromal Tumour

Hyperurecemia causes urates to be deposited in the skin and sometimes the subcutaneous fat.

Gouty tophi are the pathognomonic hallmark of gout.

They are formed by large aggregations of urate crystals surrounded by an intense inflammatory reaction of macrophages, lymphocytes and large foreign body giant cells which may have completely or partially engulfed mass of crystals.

Tophi may appear in the articular cartilage of joints and also in the periarticular ligaments, tendons and soft tissues including the olecranon and patellar bursae, Achilles tendons, and ear lobes. Less frequently they may appear in the kidneys, nasal cartilages, skin of the fingertips, palms and sole. Superficial tophi can lead to large ulcerations of the overlying skin.

Visit: FOREIGN BODY GRANULOMA OF SKIN

Histopathological features:

Image Link1 ; Image Link2 ;

Image Link3 ; Image Link4.

Pale basophilic granular material represents the proteinaceous matrix in which there are needle-like spaces in radial arrangement . These spaces represent outlines of urate crystals that have been dissolved by aqueous fixative.
The pale basophilic area is surrounded by abundant histiocytes and foreign body type of giant cells.

Note: Fixation in alcohol is important for the preservation of sodium urate monohydrate deposits that appear as needle-shaped,doubly refractile crystals.
With De Galantha's stain, urate crystals appear brown-black.

Differential diagnosis:

-Rheumatoid nodule -click: Palisading of histiocytes may be a source of confusion with rheumatoid nodule.

-Chondrocalcinosis (pseudogout).

- Calcinosis Cutis- click: - Calcified nodules of scrotum or vulva.

Abstracts:

Gout as an unusual cause of pelvic pain.Ned Tijdschr Geneeskd. 2006 Jan 21;150(3):151-4.

Tophaceous gout in the bipartite patella with intra-osseous and intra-articular lesions: a case report.J Orthop Surg (Hong Kong). 2005 Aug;13(2):199-202.

Histopathologic examination of conjunctival tophi in gouty arthritis.Am J Ophthalmol. 2005 Dec;140(6):1152-4.

Gouty tophi: a squamous cell carcinoma mimicker?Dermatol Surg. 2002 Jul;28(7):636-8.

Tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease).Hum Pathol. 1995 Jun;26(6):587-93.

Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis.Mod Pathol. 2001 Aug;14(8):806-10.

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Granulomatous Reaction Pattern of the Skin

Granuloma Annulare

Necrobiosis Lipoidica

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Verruciform Xanthoma

Xanthelasma

Pathology of the Eyelid

Inflammatory diseases of the Eyelid

Tumour and tumour-like lesions of the Eyelid

Adnexal Tumours of the eyelid

Epidermal tumours of the Eyelid

Mesenchymal Tumours of the Eyelid

Melanocytic tumours of the Eyelid