Gout

Case 17   July 2010 (P McKee) 

Needle-shaped crystals dissolve in formalin and need to be preserved in alcohol.  Amorphous material remains stimulating granulomatous reaction.  Negative birefringence cf. oxalate crystals which are yellow-blue 

Case 280  July 2011 (P. McKee)  M 65. Painful foot.  Ankle nodule 

Needle shaped “sheaves of wheat” crystals.  Surrounding histiocytic response. 

Case 316   Aug 2011 (P. McKee)  M 32 painful nodules 

Numerous grey-brown fronded, almost vegetative structures – these are tophi fixed in alcohol.  Adjacent bone is a red herring. 

Case 591 13.9.12 (P. McKee) M 40 painful nodule foot 

Amorphous pink/grey areas correspond to where the urate crystals have been dissolved during formalin fixation.  Surrounding granulomatous response. 

Case 1333  3.8.15 (M. Hurt)  M 72 DIP joint (*teaching) 

Cracking demo.  Pallisaded granulomas around crystals 

Case 1665  11.11.16 (R. Carr)  Pimple on ear enlarging after trauma. (*teaching) 

Pseudoepitheliomatous hyperplasia.  Crystals just about discernible on H+E but beautifully demonstrated on polarisation. 

Case 2652 4.9.20  (R. Carr)  M 85 finger – shave of ulcerated nodule 

Mostly transepidermally eliminated neutrophilic debris.  Small amount of dermis present shows a focus of feathery, tophus material. 

Case 2679  13.10.20 (U. Sundram) F 48 ear (*teaching) 

Case 3019 1.2.22 (U.Sundram) M 73 “cyst” on ear 

Nice sheaves of wheat 

Case 3060  30.3.22 (H. Diwan)  M 71 lesion upper helix 

More sheaves of wheat. 

Case 4266  29.5.23 (M. Abdel-Halim)  M 43 firm papules around joints 

Another nice example 

Case 4283  21.6.23  (H. Diwan)  M 47 ear lesion