Case Number : Case 3019 - 1 February 2022 Posted By: Uma Sundram

Gouty tophus.

Agree

27 minutes ago, Richard Logan said:

Gouty tophus.

Agree

Gout like mr. Logan said! Can we see polarized photos?

Agree with gouty typhus. 

can we consider amyloid as Differential diagnosis and do special stain and exclude it, considering the age of patient

Agree with Gout

4 hours ago, Krishnakumar subramanian said:

can we consider amyloid as Differential diagnosis and do special stain and exclude it, considering the age of patient

There is a fronded, "sheaves of wheat" appearance, seen particularly in the lower, right image which suggests gout.  Amyloid is rather more amorphous.

agreed sir

6 hours ago, Richard Logan said:

There is a fronded, "sheaves of wheat" appearance, seen particularly in the lower, right image which suggests gout.  Amyloid is rather more amorphous.

Nice  analogy, Richard: "sheaves of wheat”. I’ll make it mine, if you don’t mind :--)

Gout

21 hours ago, vincenzo said:

Nice  analogy, Richard: "sheaves of wheat”. I’ll make it mine, if you don’t mind :--)

I picked up the "sheaves of wheat" analogy from Phillip McKee's case 280, July 2011, where it was quoted by Andrew Danckwerts.  I don't know who the originator was.  Case 280 shows the morphology very well.

Thanks sir

Gout.