Difference between revisions of "Crystals in body fluids"

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[[Image:Gout_-_monosodium_urate_crystals_(20X,_polarized,_red_compensator).jpg|thumb|right|Crystals (gout) and blood cells in [[polarized light]]. (WC/Gabriel Caponetti)]]
[[Image: Crystals in urine - uc -- very high mag - animation.gif | Crystals - very high mag.|thumb|right|Crystals in urine. (WC)]]
This article deals with '''crystals in body fluids'''.
This article deals with '''crystals in body fluids'''.


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*Diamond shape (uric acid).  
*Diamond shape (uric acid).  
*Coffin-lid shape (struvite).
*Coffin-lid shape (struvite).
*Hexagonal shape (cysteine).
*Hexagonal shape ([[cystinosis|cysteine]]).


Notes:
Notes:
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**''Diamonds'' are see-through; ergo, uric acid stones not seen on KUB.
**''Diamonds'' are see-through; ergo, uric acid stones not seen on KUB.
**Calcium oxalat'''e''' = '''e'''nvelope, uric aci'''d''' = '''d'''iamond.
**Calcium oxalat'''e''' = '''e'''nvelope, uric aci'''d''' = '''d'''iamond.
*Uric acid crystals: usually dissolve in [[formalin]]... but do not dissolve in alcohol.<ref>WG. 8 January 2010.</ref>
*Uric acid crystals: usually dissolve in [[formalin]]... but do not dissolve in alcohol.<ref>Geddie, W. 8 January 2010.</ref><ref>{{Cite journal  | last1 = Shidham | first1 = V. | last2 = Chivukula | first2 = M. | last3 = Basir | first3 = Z. | last4 = Shidham | first4 = G. | title = Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis. | journal = Mod Pathol | volume = 14 | issue = 8 | pages = 806-10 | month = Aug | year = 2001 | doi = 10.1038/modpathol.3880394 | PMID = 11504841 }}</ref>
*Calcium oxalate crystals are seen in the context of [[ethylene glycol]] poisoning.<ref name=Ref_KFP589>{{Ref KFP|589}}</ref>
*Calcium oxalate crystals are seen in the context of [[ethylene glycol]] poisoning.<ref name=Ref_KFP589>{{Ref KFP|589}}</ref>


=Diseases=
===Images===
==Gout==
<gallery>
===General===
Image:Struvite_crystals_dog_with_scale_1.JPG | Struvite crystals. (WC)
*Classically afflicts the big toe - known as '''podagra'''.
Image: Uric acid crystals (urine) - Ürik asit kristalleri (idrar) - 03.png | Uric acid crystals. (WC)
Image: Calcium oxalate crystals in urine.jpg | Calcium oxalate crystal - envelope-shaped. (WC)
Image: Fluorescent uric acid.JPG | Uric acid crystals. (WC)
</gallery>
====Case====
<gallery>
Image: Crystals in urine - uc -- high mag.jpg | Crystals - high mag.
Image: Crystals in urine - uc - alt -- high mag.jpg | Crystals - high mag.


Etiology:<ref name=Ref_PCPBoD8>{{Ref PCPBoD8|634}}</ref>
Image: Crystals in urine - uc -- very high mag.jpg | Crystals - very high mag.
*Overproduction of uric acid ~ 10% of cases.
Image: Crystals in urine - uc - alt -- very high mag.jpg | Crystals - very high mag.
*Reduced excretion of uric acid ~ 90% of cases.
Image: Crystals in urine - uc - alt 2 -- very high mag.jpg | Crystals - very high mag.
**May be genetic, e.g. URAT1 mutation.<ref name=omim607096>{{OMIM|607096}}</ref><ref>{{Cite journal  | last1 = Tin | first1 = A. | last2 = Woodward | first2 = OM. | last3 = Kao | first3 = WH. | last4 = Liu | first4 = CT. | last5 = Lu | first5 = X. | last6 = Nalls | first6 = MA. | last7 = Shriner | first7 = D. | last8 = Semmo | first8 = M. | last9 = Akylbekova | first9 = EL. | title = Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele. | journal = Hum Mol Genet | volume = 20 | issue = 20 | pages = 4056-68 | month = Oct | year = 2011 | doi = 10.1093/hmg/ddr307 | PMID = 21768215 }}</ref>
</gallery>
**Renal failure.
====www====
*[https://en.wikipedia.org/wiki/File:Uric_acid_crystals.jpg Uric acid crystals - schematic from 1844. (wikipedia.org)]


===Gross/radiology===
===Sign out===
*Radiologically may mimic ''anconeus epitrochlearis'' muscle.<ref>URL: [http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213 http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213]. Accessed on: 7 August 2011.</ref>
====Urine cytology====
<pre>
Negative for malignant cells.
Mainly squamous cells present. Cuboidal/rhomboidal crystals present.
</pre>


===Microscopic===
=Diseases=
Features:<ref>URL: [http://pathologyoutlines.com/joints.html#gout http://pathologyoutlines.com/joints.html#gout]. Accessed on: 5 August 2011.</ref>
==Gout==
*Tophi (advanced)
{{Main|Gout}}
**Reactive granulomatous inflammation.
***Surrounds fluffy (cotton candy-like) material.
**Fibrotic synovium.
**Aggregates of urate crystals.
 
Images:
*[http://www.archivesofpathology.org/na101/home/literatum/publisher/pinnacle/journals/content/arpa/2002/15432165-126.5/0003-9985%282002%29126%3C0621%3Apqcast%3E2.0.co%3B2/production/images/large/i1543-2165-126-5-621-f01.jpeg Gouty tophus - A. xray, B. Diff-Quick, C. Pap smear, D. polarized light, E. H&E (archivesofpathology.org)].
*[http://commons.wikimedia.org/wiki/File:Gouty_tophus_-_low_mag.jpg Gouty tophus - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Gouty_tophus_-_high_mag.jpg Gouty tophus - high mag. (WC)].
*[http://path.upmc.edu/cases/case205.html Gout - several images (upmc.edu)].


==Pseudogout==
==Pseudogout==
: ''Chondrocalcinosis'' redirects here.
*[[AKA]] ''Calcium pyrophosphate dihydrate deposition disease'',<ref>URL: [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/]. Accessed on: 28 October 2011.</ref> abbreviated ''CPPD''.
*[[AKA]] ''Calcium pyrophosphate dihydrate deposition disease'',<ref>URL: [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/]. Accessed on: 28 October 2011.</ref> abbreviated ''CPPD''.
===General===
{{Main|Chondrocalcinosis}}
*Classically found in the knee.
*Associated with low bone mineral density and vascular calcification.<ref name=pmid23912799>{{Cite journal  | last1 = Abhishek | first1 = A. | last2 = Doherty | first2 = S. | last3 = Maciewicz | first3 = R. | last4 = Muir | first4 = K. | last5 = Zhang | first5 = W. | last6 = Doherty | first6 = M. | title = Association between low cortical bone mineral density, soft-tissue calcification, vascular calcification and chondrocalcinosis: a case-control study. | journal = Ann Rheum Dis | volume =  | issue =  | pages =  | month = Aug | year = 2013 | doi = 10.1136/annrheumdis-2013-203400 | PMID = 23912799 }}</ref>
 
===Radiology===
*Similar to [[osteoarthritis]] - joint space narrowing & subchondral sclerosis.<ref name=learningrads>URL: [http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm]. Accessed on: 9 October 2013.</ref>
 
Findings suggestive of CPPD:<ref name=learningrads>URL: [http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm]. Accessed on: 9 October 2013.</ref>
*Subchondral cysts (large) - important.
*Intra-articular bodies, several.
*Increased narrowing of patellofemoral joint.
 
===Microscopic===
Features:
*Crystals with a rhomboid-shape.
**Positively birefringent, blue when aligned.
 
Notes:
*Memory device: ''ABC+'' = ''a''ligned ''b''lue is ''c''alcium & ''c''uboid - positively birefringent.
 
====Images====
<gallery>
Image:Pseudogout_-_intermed_mag.jpg | Pseudogout - intermed. mag. (WC)
Image:Pseudogout_-_high_mag.jpg | Pseudogout - high mag. (WC)
</gallery>
www:
*[http://ard.highwire.org/content/58/5/261/F2.large.jpg Pseudogout (highwire.org)].<ref name=pmid10225806>{{Cite journal  | last1 = Dieppe | first1 = P. | last2 = Swan | first2 = A. | title = Identification of crystals in synovial fluid. | journal = Ann Rheum Dis | volume = 58 | issue = 5 | pages = 261-3 | month = May | year = 1999 | doi =  | PMID = 10225806 | PMC = 1752883 | URL = http://ard.highwire.org/content/58/5/261.full }}</ref>
 
===Sign-out===
<pre>
KNEE - BONE AND SOFT TISSUE, RIGHT, KNEE ARTHROPLASTY:
- DEGENERATIVE JOINT DISEASE WITH SYNOVIAL HYPERPLASIA AND MINIMAL INFLAMMATION.
- CRYSTALLINE DEPOSITS CONSISTENT WITH PSEUDOGOUT.
- BONE WITH THIN TRABECULAE.
</pre>
 
====Micro====
The soft tissue section shows readily apparent rhomboid-shaped crystalline deposits
(compatible with pseudogout). The crystals polarize and have a light blue hue under
polarized light. The bony section show thin bony trabeculae and cartilage with
degenerative changes (surface fibrillation, thinning).


=See also=
=See also=
*[[Cytopathology]].
*[[Cytopathology]].
*[[Medical renal diseases]].
*[[Medical renal diseases]].
*[[Nephrolithiasis]] - kidney stones.
*[[Polarized light]].


=References=
=References=
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=External links=
=External links=
*[http://granuloma.homestead.com/foreignbody2.html Foreign body granulomas (granuloma.homestead.com)].
*[http://granuloma.homestead.com/foreignbody2.html Foreign body granulomas (granuloma.homestead.com)].
*[http://www.eclinpath.com/atlas/urinalysis/urine-crystals/nggallery/page/3 Urine cytology - veterinary medicine (eclinpath.com)].


[[Category:Clinical]]
[[Category:Clinical]]

Latest revision as of 04:58, 24 April 2016

Crystals (gout) and blood cells in polarized light. (WC/Gabriel Caponetti)
Crystals in urine. (WC)

This article deals with crystals in body fluids.

Crystals

Joint crystals

Types:[1]

  • Gout = needle-shaped, negatively birefringent, yellow when aligned.
  • Pseudogout = rhomboid-shaped, positively birefringent, blue when aligned.

Notes:

  • Pseudogout also known as CPPD = calcium pyrophosphate dehydrogenase.
  • Memory device: ABC+ = aligned blue is calcium & cuboid - positively birefringent.

Urine crystals

Types - morphology:

  • Envelope shape (calcium oxalate).
  • Diamond shape (uric acid).
  • Coffin-lid shape (struvite).
  • Hexagonal shape (cysteine).

Notes:

  • Memory devices:
    • Diamonds are see-through; ergo, uric acid stones not seen on KUB.
    • Calcium oxalate = envelope, uric acid = diamond.
  • Uric acid crystals: usually dissolve in formalin... but do not dissolve in alcohol.[2][3]
  • Calcium oxalate crystals are seen in the context of ethylene glycol poisoning.[4]

Images

  • Struvite crystals. (WC)

  • Uric acid crystals. (WC)

  • Calcium oxalate crystal - envelope-shaped. (WC)

  • Uric acid crystals. (WC)

Case

  • Crystals - high mag.

  • Crystals - high mag.

  • Crystals - very high mag.

  • Crystals - very high mag.

  • Crystals - very high mag.

www

Sign out

Urine cytology

Negative for malignant cells.
Mainly squamous cells present. Cuboidal/rhomboidal crystals present.

Diseases

Gout

Main article: Gout

Pseudogout

  • AKA Calcium pyrophosphate dihydrate deposition disease,[5] abbreviated CPPD.
Main article: Chondrocalcinosis

See also

References

  1. ↑ Yeung, J.C.; Leonard, Blair J. N. (2005). The Toronto Notes 2005 - Review for the MCCQE and Comprehensive Medical Reference (2005 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. RH6. ISBN 978-0968592854.
  2. ↑ Geddie, W. 8 January 2010.
  3. ↑ Shidham, V.; Chivukula, M.; Basir, Z.; Shidham, G. (Aug 2001). "Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis.". Mod Pathol 14 (8): 806-10. doi:10.1038/modpathol.3880394. PMID 11504841.
  4. ↑ Saukko, Pekka; Knight, Bernard (2004). Knight's Forensic Pathology (3rd ed.). A Hodder Arnold Publication. pp. 589. ISBN 978-0340760444.
  5. ↑ URL: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/. Accessed on: 28 October 2011.

External links

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