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| *[http://library.med.utah.edu/WebPath/jpeg3/BONE044.jpg RA (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html]. Accessed on: 5 December 2010.</ref> | | *[http://library.med.utah.edu/WebPath/jpeg3/BONE044.jpg RA (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html]. Accessed on: 5 December 2010.</ref> |
| *[http://www.nature.com/nature/journal/v423/n6937/fig_tab/nature01661_F1.html Rheumatoid arthritis (nature.com)]. | | *[http://www.nature.com/nature/journal/v423/n6937/fig_tab/nature01661_F1.html Rheumatoid arthritis (nature.com)]. |
| *[http://www.medpath.info/MainContent/Skeletal/3100.GIF Synovial hyperplasia and inflammation (medpath.info)].<ref name=medpath/> | | *[http://www.medpath.info/MainContent/Skeletal/3100.GIF Synovial inflammation (medpath.info)].<ref name=medpath/> |
| | *[http://www.medpath.info/MainContent/Skeletal/3109.GIF Hyperplastic synovitis (medpath.info)].<ref name=medpath/> |
| *[http://ard.bmj.com/content/58/3.cover-expansion RA cartilage loss (bmj.com)]. | | *[http://ard.bmj.com/content/58/3.cover-expansion RA cartilage loss (bmj.com)]. |
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| ====Hand==== | | ====Hand==== |
| | <pre> |
| | Right Hand - Metacarpal Heads of Index Finger, Middle Finger and Ring Finger, Excision: |
| | - Benign bone and cartilage focally associated with fibrous tissue and erosions. |
| | - Fatty marrow space. |
| | - NEGATIVE for significant inflammation. |
| | - NEGATIVE for malignancy. |
| | |
| | Comment: |
| | The history of rheumatoid arthritis and deformities is noted. |
| | </pre> |
| | |
| <pre> | | <pre> |
| SYNOVIUM, LEFT HAND, EXCISION: | | SYNOVIUM, LEFT HAND, EXCISION: |
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| ==Rheumatoid nodule== | | ==Rheumatoid nodule== |
| {{ Infobox external links | | {{Main|Rheumatoid nodule}} |
| | Name = Rheumatoid nodule | | {{Main|Rheumatoid lung nodule}} |
| | EHVSC = 10182
| |
| | pathprotocols =
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| | wikipedia =
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| | pathoutlines =
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| }}
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| *Abbreviated ''RN''.
| |
| ===General===
| |
| *Seen in [[rheumatoid arthritis]] - usually only in seropositive cases, i.e. ''rheumatoid factor'' (RF) positive.<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref>
| |
| **Exceptions are reported.<ref name=pmid6364806>{{Cite journal | last1 = Kaye | first1 = BR. | last2 = Kaye | first2 = RL. | last3 = Bobrove | first3 = A. | title = Rheumatoid nodules. Review of the spectrum of associated conditions and proposal of a new classification, with a report of four seronegative cases. | journal = Am J Med | volume = 76 | issue = 2 | pages = 279-92 | month = Feb | year = 1984 | doi = | PMID = 6364806 }}</ref>
| |
| | |
| ===Gross===
| |
| *Usually on the extensor aspect of the extremities, e.g. dorsal aspect of elbow.<ref name=Ref_Derm53>{{Ref Derm|53}}</ref>
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| *Typically close to a joint.{{fact}}
| |
| | |
| ===Microscopic===
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| Features:<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref><ref name=Ref_Derm52>{{Ref Derm|52}}</ref>
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| *Necrotic collagen bundles with fibrin surrounded by:
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| **Palisading [[granuloma]].
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| *+/-Eosinophils.
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| | |
| Notes:
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| *Histomorphologically very similar to ''[[Granuloma annulare]]''.
| |
| | |
| DDx:
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| *[[Granuloma annulare]] - has mucin in the core of the granuloma.<ref name=Ref_Derm52>{{Ref Derm|52}}</ref>
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| *[[Necrobiosis lipoidica]].
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| | |
| ===Images===
| |
| www:
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| *[http://granuloma.homestead.com/rheumatoid_nod_S89-2617-1.jpg Rheumatoid nodule (granuloma.homestead.com)].<ref name=ghc>URL: [http://granuloma.homestead.com/palisading.html http://granuloma.homestead.com/palisading.html]. Accessed on: 1 November 2010.</ref>
| |
| *[http://granuloma.homestead.com/rheumatoid_nod_S89-2617-5.jpg Rheumatoid nodule (granuloma.homestead.com)].<ref name=ghc>URL: [http://granuloma.homestead.com/palisading.html http://granuloma.homestead.com/palisading.html]. Accessed on: 1 November 2010.</ref>
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| *[http://library.med.utah.edu/WebPath/jpeg3/BONE045.jpg Rheumatoid nodule (utah.edu)].<ref>URL: [http://www.pathguy.com/lectures/joints.htm http://www.pathguy.com/lectures/joints.htm]. Accessed on: 1 November 2010.</ref>
| |
| <gallery>
| |
| Image:Rheumatoid_nodule_-_low_mag.jpg |Rheumatoid nodule - low mag. (WC)
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| Image:Rheumatoid_nodule_-_intermed_mag_2.jpg |Rheumatoid nodule - intermed. mag. (WC)
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| Image:Rheumatoid_nodule_-_high_mag.jpg |Rheumatoid nodule - high mag. (WC)
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| </gallery>
| |
| | |
| ===Sign out===
| |
| <pre>
| |
| Lesion (subcutaneous), right index finger, excision:
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| - Palisading granulomas with cores of necrobiotic collagen, consistent with rheumatoid nodule.
| |
| </pre>
| |
| | |
| ====Micro====
| |
| The sections show foci with strands of necrobiotic collagen surrounded by palisading granulomas. Rare Neutrophils are seen in the core of the granulomas. Multinucleated cells are not apparent.
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| | |
| Benign fibroadipose tissue and dense connective tissue are also present.
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| =Pleural disease= | | =Pleural disease= |
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| =External links= | | =External links= |
| *[http://www.pathguy.com/lectures/joints.htm Joint disease (pathguy.com)]. | | *[http://www.pathguy.com/lectures/joints.htm Joint disease (pathguy.com)]. |
| | |
| [[Category:Weird stuff]] | | [[Category:Weird stuff]] |
| | [[Category:Diagnosis]] |