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# | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Gouty_tophus_-_high_mag.jpg | |||
| Width = | |||
| Caption = Gouty tophus. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = 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 | |||
| Subtypes = | |||
| LMDDx = | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[joints]] - classically large toe | |||
| Assdx = +/-[[chronic renal failure]], +/-[[diabetes mellitus]] | |||
| Syndromes = | |||
| Clinicalhx = usually male | |||
| Signs = | |||
| Symptoms = joint pain | |||
| Prevalence = common | |||
| Bloodwork = urea elevated | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = other causes of joint pain - see ''[[arthritis]]'' | |||
| Tx = medications (NSAIDs for pain, allopurinol, colchicine) | |||
}} | |||
'''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]]. | |||
==General== | |||
*Classically afflicts the big toe - known as '''podagra'''. | |||
Epidemiology:<ref name=pmid22544037>{{Cite journal | last1 = Wang | first1 = Y. | last2 = Yan | first2 = S. | last3 = Li | first3 = C. | last4 = Zhao | first4 = S. | last5 = Lv | first5 = J. | last6 = Wang | first6 = F. | last7 = Meng | first7 = D. | last8 = Han | first8 = L. | last9 = Wang | first9 = Y. | title = Risk factors for gout developed from hyperuricemia in China: a five-year prospective cohort study. | journal = Rheumatol Int | volume = 33 | issue = 3 | pages = 705-10 | month = Mar | year = 2013 | doi = 10.1007/s00296-012-2439-8 | PMID = 22544037 }}</ref> | |||
*Male (Females relative risk ~ 0.1). | |||
*Renal failure. | |||
*Diabetes mellitus. | |||
Etiology:<ref name=Ref_PCPBoD8>{{Ref PCPBoD8|634}}</ref> | |||
*Overproduction of uric acid ~ 10% of cases. | |||
*Reduced excretion of uric acid ~ 90% of cases. | |||
**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> | |||
**Renal failure. | |||
Treatments:<ref name=pmid17910294>{{Cite journal | last1 = Eggebeen | first1 = AT. | title = Gout: an update. | journal = Am Fam Physician | volume = 76 | issue = 6 | pages = 801-8 | month = Sep | year = 2007 | doi = | PMID = 17910294 }}</ref> | |||
*NSAIDs. | |||
*Allopurinol. | |||
*Colchicine - prophylatic. | |||
==Gross/radiology== | |||
*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> | |||
DDx: | |||
*[[Epidermal inclusion cyst]]. (???) | |||
==Microscopic== | |||
Features:<ref>URL: [http://pathologyoutlines.com/joints.html#gout http://pathologyoutlines.com/joints.html#gout]. Accessed on: 5 August 2011.</ref> | |||
*Tophi (advanced) | |||
**Reactive granulomatous inflammation. | |||
***Surrounds fluffy (cotton candy-like) material. | |||
**Fibrotic synovium. | |||
*Aggregates of urate crystals - considered ''gold standard''.<ref name=pmid26175247>{{Cite journal | last1 = Ting | first1 = K. | last2 = Graf | first2 = SW. | last3 = Whittle | first3 = SL. | title = Update on the diagnosis and management of gout. | journal = Med J Aust | volume = 203 | issue = 2 | pages = 86-8 | month = Jul | year = 2015 | doi = | PMID = 26175247 }}</ref> ‡ | |||
Note: | |||
*‡ The crystals with the classically described [[polarization of light]] (see ''[[crystals in body fluids]]'') is ''not'' present in [[formalin]] fixed tissue.<ref name=pmid11504841>{{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> | |||
===Images=== | |||
<gallery> | |||
Image:Gouty_tophus_-_low_mag.jpg | Gouty tophus - low mag. (WC) | |||
Image:Gouty_tophus_-_high_mag.jpg | Gouty tophus - high mag. (WC) | |||
Gout - monosodium urate crystals (20X, polarized, red compensator).jpg | Urate crystals under [[polarized light]]. (WC/Gabriel Caponetti) | |||
</gallery> | |||
====www==== | |||
*[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://path.upmc.edu/cases/case205.html Gout - several images (upmc.edu)]. | |||
==Sign out== | |||
<pre> | |||
Submitted as "Left Olecranon Bursa", Excision: | |||
- Consistent with gouty tophus; amorphous material with granulomatous reaction. | |||
</pre> | |||
==See also== | |||
*[[Crystals in body fluids]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | |||
[[Category:Crystals in body fluids]] | |||