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LETTER TO EDITOR  
Year : 2014  |  Volume : 57  |  Issue : 3  |  Page : 511-512
Relevance of synovial cells in gouty tophus on fine needle aspiration cytology


1 Senior Resident, Department of Pathology, UCMS and GTB Hospital, Dilshad Garden, Delhi, India
2 Professor, Department of Pathology, UCMS and GTB Hospital, Dilshad Garden, Delhi, India

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Date of Web Publication14-Aug-2014
 

How to cite this article:
Tomar R, Srivastava R, Arora VK. Relevance of synovial cells in gouty tophus on fine needle aspiration cytology. Indian J Pathol Microbiol 2014;57:511-2

How to cite this URL:
Tomar R, Srivastava R, Arora VK. Relevance of synovial cells in gouty tophus on fine needle aspiration cytology. Indian J Pathol Microbiol [serial online] 2014 [cited 2022 Dec 6];57:511-2. Available from: https://www.ijpmonline.org/text.asp?2014/57/3/511/138811


Editor,

Gouty tophus is a chronic disease with patients presenting with peri-articular, intra-articular and soft tissue nodules. Fine-needle aspiration cytology (FNAC) is a simple, economical and convenient diagnostic investigation in gouty tophus almost replacing synovial biopsy. [1] Tophus infiltration into bone is the dominant mechanism for the development of bone erosion and joint damage in gout. [2]

Presence of negatively birefringent needle shaped crystals and plates of monosodium urate (MSU) on FNAC are the pathognomic morphological feature in gout. [3],[4] Presence of synovial cells in aspirates from gouty tophi is not highlighted in the literature however; Gandhi et al. described presence of synovial cells around the sheaves of the urate crystal. [5]

Six patients with painful peri-articular and soft tissue swellings were clinically, radiologically and cytologically evaluated including serum uric acid levels which were marginally elevated to 7.8 mg/dL in one patient and normal in others. X-ray revealed features ranging from soft tissue swelling with multiple punched out lesion with sclerotic edges to well-defined erosion. Fine-needle aspiration smears showed needle shaped urate crystals, inflammatory cells, macrophages and giant cells (GC). Synovial cells were observed in aspirates in patient 1 and 3. They were present in clusters and singly scattered between the urate crystals. Acute inflammatory cells were seen with urate crystals in patients 2, 3 and 4. Polarizing microscopy revealed negatively birefringent MSU crystals [Figure 1]. Final cytological diagnosis of gouty tophus was established in all cases with an additional suggestion of intra-bursal/intra-articular location of gouty tophus in patients 1 and 3 on basis of presence of synovial cells, and acute gouty arthritis or impending arthritis in patients 2, 3 and 4 on basis of presence of acute inflammatory cells [Table 1].
Table 1: Clinical and cytomorphological findings of the cases of gouty tophus

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Figure 1: May-Grünwald-Giemsa stained smear showing cluster of synovial cells surrounded and covered by negatively birefringent MSU crystals

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Presence of MSU crystals, amorphous granular background and chronic inflammatory cells has been found in all previous reports similar to the present study. [1],[3],[5] Significance of Acute inflammatory cells highlighted in this work were not appreciated in any other study except Bhadani et al. [3] Synovial cells were not described in any case report except Gandhi et al., [5] and present study. Apart from the above mentioned facts about gouty tophus, we observed the presence of synovial cells in two of our six cases, which were arranged in small clusters and singly in between the MSU crystals, which suggests intra-articular or intra-bursal location of the lesion, which is correlated with radiological findings. In addition to histiocytes, lymphocytes, GC and MSU crystals neutrophils were seen in three out of six patients, which may indicate an impending or acute gouty arthritis.

Intra-articular or intra-bursal location of gouty tophus, impending and acute gouty arthritis can be suggested on morphological basis on cytopathology and can be useful information to the orthopedic surgeon in preventing and managing complications of impending bone erosion and joint damage.

Therefore, we emphasize the need for recognizing the synovial cells and neutrophils while dealing with a case of gouty tophus by the cytopathologist



 
   References Top

1.
Agarwal K, Pahuja S, Agarwal C, Harbhanjanka A. Fine needle aspiration cytology of gouty tophi with review of literature. J Cytol 2007;24:142-5.  Back to cited text no. 1
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2.
Dalbeth N, Clark B, Gregory K, Gamble G, Sheehan T, Doyle A, et al. Mechanisms of bone erosion in gout: A quantitative analysis using plain radiography and computed tomography. Ann Rheum Dis 2009;68:1290-5.  Back to cited text no. 2
    
3.
Bhadani PP, Sah SP, Sen R, Singh RK. Diagnostic value of fine needle aspiration cytology in gouty tophi: A report of 7 cases. Acta Cytol 2006;50:101-4.  Back to cited text no. 3
    
4.
Sen B, Arora VK, Gupta K, Bhatia A. Platelike urate crystals in gouty tophi. Acta Cytol 1993;37:640-1.  Back to cited text no. 4
    
5.
Gandhi A, Aggarwal S, Rajbongshi A, Arora VK. Bursal gouty tophus: Fine-needle aspiration cytology intrabursal tophus on FNAC. Diagn Cytopathol 2010;38:463-4.  Back to cited text no. 5
    

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Correspondence Address:
Reena Tomar
Senior Resident, Department of Pathology, UCMS and GTB Hospital, Dilshad Garden, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.138811

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