Gout
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Gout is a common benign affliction that can be disabling. It occasionally is seen by pathologists. It can be grouped in conditions with crystals in body fluids.
| Gout | |
|---|---|
| Diagnosis in short | |
 Gouty tophus. H&E stain. | |
|
| |
| LM | urate crystals - considered gold standard (see crystals in body fluids) not seen on formalin fixed sections, tophi (granulomatous inflammation - surrounds fluffy (cotton candy-like) material), fibrotic synovium |
| Site | joints - classically large toe |
|
| |
| Associated Dx | +/-chronic renal failure, +/-diabetes mellitus |
| Clinical history | usually male |
| Symptoms | joint pain |
| Prevalence | common |
| Blood work | urea elevated |
| Prognosis | benign |
| Clin. DDx | other causes of joint pain - see arthritis |
| Treatment | medications (NSAIDs for pain, allopurinol, colchicine) |
General
- Classically afflicts the big toe - known as podagra.
Epidemiology:[1]
- Male (Females relative risk ~ 0.1).
- Renal failure.
- Diabetes mellitus.
Etiology:[2]
- Overproduction of uric acid ~ 10% of cases.
- Reduced excretion of uric acid ~ 90% of cases.
Treatments:[5]
- NSAIDs.
- Allopurinol.
- Colchicine - prophylatic.
Gross/radiology
- Radiologically may mimic anconeus epitrochlearis muscle.[6]
DDx:
- Epidermal inclusion cyst. (???)
Microscopic
Features:[7]
- Tophi (advanced)
- Reactive granulomatous inflammation.
- Surrounds fluffy (cotton candy-like) material.
- Fibrotic synovium.
- Reactive granulomatous inflammation.
- Aggregates of urate crystals - considered gold standard.[8] ‡
Note:
- ‡ The crystals with the classically described polarization of light (see crystals in body fluids) is not present in formalin fixed tissue.[9]
Images
Gouty tophus - low mag. (WC)
Gouty tophus - high mag. (WC)
Urate crystals under polarized light. (WC/Gabriel Caponetti)
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Submitted as "Left Olecranon Bursa", Excision:
- Consistent with gouty tophus; amorphous material with granulomatous reaction.
See also
References
- ↑ Wang, Y.; Yan, S.; Li, C.; Zhao, S.; Lv, J.; Wang, F.; Meng, D.; Han, L. et al. (Mar 2013). "Risk factors for gout developed from hyperuricemia in China: a five-year prospective cohort study.". Rheumatol Int 33 (3): 705-10. doi:10.1007/s00296-012-2439-8. PMID 22544037.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 634. ISBN 978-1416054542.
- ↑ Online 'Mendelian Inheritance in Man' (OMIM) 607096
- ↑ Tin, A.; Woodward, OM.; Kao, WH.; Liu, CT.; Lu, X.; Nalls, MA.; Shriner, D.; Semmo, M. et al. (Oct 2011). "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.". Hum Mol Genet 20 (20): 4056-68. doi:10.1093/hmg/ddr307. PMID 21768215.
- ↑ Eggebeen, AT. (Sep 2007). "Gout: an update.". Am Fam Physician 76 (6): 801-8. PMID 17910294.
- ↑ URL: http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213. Accessed on: 7 August 2011.
- ↑ URL: http://pathologyoutlines.com/joints.html#gout. Accessed on: 5 August 2011.
- ↑ Ting, K.; Graf, SW.; Whittle, SL. (Jul 2015). "Update on the diagnosis and management of gout.". Med J Aust 203 (2): 86-8. PMID 26175247.
- ↑ 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.