Microscopic Description -- Pain in Left Index Finger


Sections submitted form the skin, soft tissue and bone show clusters of non-caseating granulomata (Figs 1, 2, 3) composed of large aggregates of acellular eosinophilic to amphophilic material surrounded by an intense inflammatory reaction (Tophi). The cellar infiltrate is composed of macrophages, lymphocytes and large foreign body giant cells that completely or partially engulfed masses of crystals. Such tophi are also seen in the articular cartilage (Figs 4, 5) and in the periarticular soft tissue. In the medullary cavity they are seen surrounded by the trabecular bone fragments (Figs 6, 7). No organisms were seen with the special stains. Sections of the skin adjacent to the lesion showed ulceration, acute inflammation and ischemic changes (Fig 8).



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