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==Rheumatoid neutrophilic dermatitis== | ==Rheumatoid neutrophilic dermatitis== | ||
===General=== | ===General=== | ||
* | *Case report rare manifestation of rheumatoid arthritis.<ref name=pmid9197831>{{Cite journal | last1 = Mashek | first1 = HA. | last2 = Pham | first2 = CT. | last3 = Helm | first3 = TN. | last4 = Klaus | first4 = M. | title = Rheumatoid neutrophilic dermatitis. | journal = Arch Dermatol | volume = 133 | issue = 6 | pages = 757-60 | month = Jun | year = 1997 | doi = | PMID = 9197831 }}</ref> | ||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Nodular and diffuse pattern. | *Nodular and diffuse pattern. | ||
*[[Neutrophil]]s. | *[[Neutrophil]]s - perivascular (without vessel wall injury).<ref name=pmid9197831/> | ||
DDx: | |||
*[[Vasculitis]]. | |||
=Joints= | =Joints= | ||
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*Calor - heat. | *Calor - heat. | ||
*Dolor - pain. | *Dolor - pain. | ||
===Gross=== | |||
Features: | |||
*Pannus<ref name=Ref_Lester223>{{Ref Lester|223}}</ref> - fibrovascular tissue or granulation tissue. | |||
*Irregular surface - synovial hyperplasia. | |||
*Subchondral cysts - involve the entire femoral head (late stage of disease).<ref name=pmid404905/> | |||
Note: | |||
*[[Osteoarthritis]] subchondral cysts are associated with cartilage loss.<ref name=pmid404905>{{Cite journal | last1 = Resnick | first1 = D. | last2 = Niwayama | first2 = G. | last3 = Coutts | first3 = RD. | title = Subchondral cysts (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint. | journal = AJR Am J Roentgenol | volume = 128 | issue = 5 | pages = 799-806 | month = May | year = 1977 | doi = | PMID = 404905 }}</ref> | |||
Image: | |||
*[http://www.medpath.info/MainContent/Skeletal/732.GIF Gross image of RA (medpath.info)].<ref name=medpath>URL: [http://www.medpath.info/MainContent/Skeletal/Joint_02.html http://www.medpath.info/MainContent/Skeletal/Joint_02.html]. Accessed on: 10 November 2012.</ref> | |||
*[http://www.tumorlibrary.com/case/detail.jsp?image_id=3907 RA mimicking chondrosarcoma (tumorlibrary.com)]. | |||
===Microscopic=== | ===Microscopic=== | ||
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*Chronic inflammation, esp. lymphocytes. | *Chronic inflammation, esp. lymphocytes. | ||
**+/-Lymphoid follicles. | **+/-Lymphoid follicles. | ||
*Synovial hyperplasia - with papillary ''or'' | *Synovial hyperplasia - with papillary ''or'' polypoid architecture. | ||
**Synoviocytes may show binucleation and mild atypia. | **Synoviocytes may show binucleation and mild atypia. | ||
*+/-Fibrin. | *+/-Fibrin. | ||
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Images: | Images: | ||
*[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.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)]. | |||
===Sign out=== | ===Sign out=== | ||
====Femoral head==== | |||
<pre> | |||
FEMORAL HEAD, LEFT, HIP ARTHROPLASTY: | |||
- CHRONIC SYNOVITIS WITH SYNOVIAL HYPERPLASIA AND LOSS OF CARTILAGE. | |||
- BONE WITHOUT APPARENT PATHOLOGY. | |||
- SEE COMMENT. | |||
COMMENT: | |||
The findings are compatible with rheumatoid arthritis. | |||
</pre> | |||
====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: | ||
- SYNOVIAL HYPERPLASIA. | - SYNOVIAL HYPERPLASIA. | ||
- CHRONIC AND FOCAL ACUTE SYNOVITIS. | - CHRONIC AND FOCAL ACUTE SYNOVITIS. | ||
- FIBRINOUS EXUDATE. | |||
- GRANULATION TISSUE AND HEMOSIDERIN-LADEN MACROPHAGES. | - GRANULATION TISSUE AND HEMOSIDERIN-LADEN MACROPHAGES. | ||
- SEE COMMENT. | - SEE COMMENT. | ||
COMMENT: | COMMENT: | ||
The findings are | The findings are compatible with rheumatoid arthritis. | ||
</pre> | </pre> | ||
== | ====Knee==== | ||
= | <pre> | ||
KNEE - BONE AND SOFT TISSUE, RIGHT, KNEE ARTHROPLASTY: | |||
- CHRONIC SYNOVITIS WITH SYNOVIAL HYPERPLASIA AND LOSS OF CARTILAGE. | |||
- BONE WITHOUT APPARENT PATHOLOGY. | |||
COMMENT: | |||
The findings are compatible with rheumatoid arthritis. | |||
</pre> | |||
<pre> | |||
KNEE - BONE AND SOFT TISSUE, LEFT, KNEE ARTHROPLASTY: | |||
- DEGENERATIVE JOINT DISEASE WITH CHRONIC SYNOVITIS AND SYNOVIAL HYPERPLASIA. | |||
- BONE WITHOUT APPARENT PATHOLOGY. | |||
COMMENT: | |||
The findings are compatible with rheumatoid arthritis. | |||
</pre> | |||
==Rheumatoid nodule== | |||
{{Main|Rheumatoid nodule}} | |||
{{Main|Rheumatoid lung nodule}} | |||
=Pleural disease= | =Pleural disease= | ||
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=See also= | =See also= | ||
*[[Arthritis]]. | *[[Arthritis]]. | ||
**[[Osteoarthritis]]. | |||
*[[Basics]]. | |||
*[[Joints]]. | *[[Joints]]. | ||
=References= | =References= | ||
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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]] |
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