Tophus - Revision history

Mikael Häggström: Note

2022-06-19T20:49:46Z

Note

← Older revision		Revision as of 16:49, 19 June 2022
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	}}		}}
	==Preparation==		==Preparation==
	A tophus specimen should be sent '''dry''' to the pathology department, and '''not''' be put in formalin.<ref group=~~notes~~ name=dissolves>Formalin dissolves the crystals.</ref>		A tophus specimen should be sent '''dry''' to the pathology department, and '''not''' be put in formalin.<ref group=note name=dissolves>Formalin dissolves the crystals.</ref>

	==Gross processing==		==Gross processing==
	[[File:Gross pathology of tophus.jpg\|thumb\|A large tophus.]]		[[File:Gross pathology of tophus.jpg\|thumb\|A large tophus.]]
	Preferably make a touch prep for polarized light microscopy. At least if urate crystals are not initially detected, take sections to be put in 100% alcohol and tell the histology lab to prepare it as per gout protocol.<ref group=~~notes~~ name=dissolves/> With characteristic crystals on a touch prep, sections may possibly be submitted in formalin.<ref group=~~notes~~ name=dissolves/>		Preferably make a touch prep for polarized light microscopy. At least if urate crystals are not initially detected, take sections to be put in 100% alcohol and tell the histology lab to prepare it as per gout protocol.<ref group=note name=dissolves/> With characteristic crystals on a touch prep, sections may possibly be submitted in formalin.<ref group=note name=dissolves/>

	==Microscopy evaluation==		==Microscopy evaluation==

Mikael Häggström: /* Microscopy evaluation */ condenser

2022-04-07T20:26:17Z

Microscopy evaluation: condenser

← Older revision		Revision as of 16:26, 7 April 2022
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	File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle-shaped crystals		File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle-shaped crystals
	File:Birefringence microscopy of gout, annotated.jpg\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>		File:Birefringence microscopy of gout, annotated.jpg\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>
	File:Birefringence microscopy of pseudogout, annotated.jpg\|In contrast, '''pseudogout''' ~~(Calcium~~ pyrophosphate dihydrate crystal deposition disease) displays rhombus-shaped or parallelogram-shaped crystals with negative birefringence.		File:Birefringence microscopy of pseudogout, annotated.jpg\|In contrast, '''pseudogout''', also called calcium pyrophosphate dihydrate (CPPD) crystal deposition disease) displays rhombus-shaped or parallelogram-shaped crystals with negative birefringence.
	File:Calcium pyrophosphate dihydrate crystals without and with condenser.jpg\|To look for crystals in a regular light microscope, look without '''condenser''' (right image) if possible, wherein ~~crystals~~ outlines are more clear than with condenser (left image).		File:Calcium pyrophosphate dihydrate crystals without and with condenser.jpg\|To look for crystals in a regular light microscope, look without '''condenser''' (right image) if possible, wherein crystal outlines are more clear than with condenser (left image). CPPD crystals are depicted.
	</gallery>		</gallery>
	{{Bottom}}		{{Bottom}}

Mikael Häggström: /* Microscopy evaluation */ +Condenser

2022-04-07T20:24:58Z

Microscopy evaluation: +Condenser

← Older revision		Revision as of 16:24, 7 April 2022
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	File:Birefringence microscopy of gout, annotated.jpg\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>		File:Birefringence microscopy of gout, annotated.jpg\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>
	File:Birefringence microscopy of pseudogout, annotated.jpg\|In contrast, '''pseudogout''' (Calcium pyrophosphate dihydrate crystal deposition disease) displays rhombus-shaped or parallelogram-shaped crystals with negative birefringence.		File:Birefringence microscopy of pseudogout, annotated.jpg\|In contrast, '''pseudogout''' (Calcium pyrophosphate dihydrate crystal deposition disease) displays rhombus-shaped or parallelogram-shaped crystals with negative birefringence.
			File:Calcium pyrophosphate dihydrate crystals without and with condenser.jpg\|To look for crystals in a regular light microscope, look without '''condenser''' (right image) if possible, wherein crystals outlines are more clear than with condenser (left image).
	</gallery>		</gallery>
	{{Bottom}}		{{Bottom}}

Mikael Häggström: /* Microscopy evaluation */ or Parallelogram

2022-04-05T13:11:58Z

Microscopy evaluation: or Parallelogram

← Older revision		Revision as of 09:11, 5 April 2022
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	File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle-shaped crystals		File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle-shaped crystals
	File:Birefringence microscopy of gout, annotated.jpg\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>		File:Birefringence microscopy of gout, annotated.jpg\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>
	File:Birefringence microscopy of pseudogout, annotated.jpg\|In contrast, '''pseudogout''' (Calcium pyrophosphate dihydrate crystal deposition disease) displays rhombus-shaped crystals with negative birefringence.		File:Birefringence microscopy of pseudogout, annotated.jpg\|In contrast, '''pseudogout''' (Calcium pyrophosphate dihydrate crystal deposition disease) displays rhombus-shaped or parallelogram-shaped crystals with negative birefringence.
	</gallery>		</gallery>
	{{Bottom}}		{{Bottom}}

Mikael Häggström: /* Microscopy evaluation */ Heights

2020-11-12T15:18:26Z

Microscopy evaluation: Heights

← Older revision		Revision as of 11:18, 12 November 2020
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	==Microscopy evaluation==		==Microscopy evaluation==
	On a touch prep, look for needle-shaped crystals of urate. On polarized light, these will have negative birefriengence.		On a touch prep, look for needle-shaped crystals of urate. On polarized light, these will have negative birefriengence.
	<gallery mode=packed>		<gallery mode=packed heights=180>
	File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle-shaped crystals		File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle-shaped crystals
	File:Birefringence microscopy of gout, annotated.jpg\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>		File:Birefringence microscopy of gout, annotated.jpg\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>

Mikael Häggström: Expanded

2020-11-12T15:18:04Z

Expanded

← Older revision		Revision as of 11:18, 12 November 2020
Line 4:		Line 4:
	}}		}}
	==Preparation==		==Preparation==
	A tophus specimen should be sent '''dry''' to the pathology department, and '''not''' be put in formalin.<ref group=notes name=dissolves>Formalin dissolves the crystals.</ref~~> A touch prep can be done initially, and at least if urate crystals are not initially detected, the specimen is submitted in 100% alcohol for microscopy evaluation.<ref group=notes name=dissolves/~~>		A tophus specimen should be sent '''dry''' to the pathology department, and '''not''' be put in formalin.<ref group=notes name=dissolves>Formalin dissolves the crystals.</ref>

	==Gross processing==		==Gross processing==
	[[File:Gross pathology of tophus.jpg\|thumb\|A large tophus.]]		[[File:Gross pathology of tophus.jpg\|thumb\|A large tophus.]]
	Preferably make a touch prep, ~~as well as~~ take sections to be put in 100% alcohol and tell the histology lab to prepare it as per gout protocol.		Preferably make a touch prep for polarized light microscopy. At least if urate crystals are not initially detected, take sections to be put in 100% alcohol and tell the histology lab to prepare it as per gout protocol.<ref group=notes name=dissolves/> With characteristic crystals on a touch prep, sections may possibly be submitted in formalin.<ref group=notes name=dissolves/>

	==Microscopy evaluation==		==Microscopy evaluation==

Mikael Häggström: /* Microscopy evaluation */ Better

2020-11-12T15:14:11Z

Microscopy evaluation: Better

← Older revision		Revision as of 11:14, 12 November 2020
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	On a touch prep, look for needle-shaped crystals of urate. On polarized light, these will have negative birefriengence.		On a touch prep, look for needle-shaped crystals of urate. On polarized light, these will have negative birefriengence.
	<gallery mode=packed>		<gallery mode=packed>
	File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle shaped crystals		File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle-shaped crystals
	File:Birefringence microscopy of gout, annotated.jpg\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>		File:Birefringence microscopy of gout, annotated.jpg\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>
	File:Birefringence microscopy of pseudogout, annotated.jpg\|In contrast, '''pseudogout''' (Calcium pyrophosphate dihydrate crystal deposition disease) displays rhombus-shaped crystals with negative birefringence.		File:Birefringence microscopy of pseudogout, annotated.jpg\|In contrast, '''pseudogout''' (Calcium pyrophosphate dihydrate crystal deposition disease) displays rhombus-shaped crystals with negative birefringence.
	</gallery>		</gallery>
	{{Bottom}}		{{Bottom}}

Mikael Häggström: /* Microscopy evaluation */ Better

2020-11-12T15:11:34Z

Microscopy evaluation: Better

← Older revision		Revision as of 11:11, 12 November 2020
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	<gallery mode=packed>		<gallery mode=packed>
	File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle shaped crystals		File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle shaped crystals
	File:~~Uric acid crystals in polarized light~~.~~png~~\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>		File:Birefringence microscopy of gout, annotated.jpg\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>
	File:Birefringence microscopy of pseudogout, annotated.jpg\|In contrast, '''pseudogout''' (Calcium pyrophosphate dihydrate crystal deposition disease) displays rhombus-shaped crystals with negative birefringence.		File:Birefringence microscopy of pseudogout, annotated.jpg\|In contrast, '''pseudogout''' (Calcium pyrophosphate dihydrate crystal deposition disease) displays rhombus-shaped crystals with negative birefringence.
	</gallery>		</gallery>
	{{Bottom}}		{{Bottom}}

Mikael Häggström: Expanded

2020-11-12T15:04:52Z

Expanded

← Older revision		Revision as of 11:04, 12 November 2020
Line 5:		Line 5:
	==Preparation==		==Preparation==
	A tophus specimen should be sent '''dry''' to the pathology department, and '''not''' be put in formalin.<ref group=notes name=dissolves>Formalin dissolves the crystals.</ref> A touch prep can be done initially, and at least if urate crystals are not initially detected, the specimen is submitted in 100% alcohol for microscopy evaluation.<ref group=notes name=dissolves/>		A tophus specimen should be sent '''dry''' to the pathology department, and '''not''' be put in formalin.<ref group=notes name=dissolves>Formalin dissolves the crystals.</ref> A touch prep can be done initially, and at least if urate crystals are not initially detected, the specimen is submitted in 100% alcohol for microscopy evaluation.<ref group=notes name=dissolves/>

			==Gross processing==
			[[File:Gross pathology of tophus.jpg\|thumb\|A large tophus.]]
			Preferably make a touch prep, as well as take sections to be put in 100% alcohol and tell the histology lab to prepare it as per gout protocol.

	==Microscopy evaluation==		==Microscopy evaluation==
Line 11:		Line 15:
	File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle shaped crystals		File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle shaped crystals
	File:Uric acid crystals in polarized light.png\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>		File:Uric acid crystals in polarized light.png\|Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it.<ref>{{cite web\|url=https://emedicine.medscape.com/article/329958-workup\|title=Gout and Pseudogout Workup\|author=Bruce M Rothschild\|website=Medscape}} Updated: Jun 30, 2020</ref>
			File:Birefringence microscopy of pseudogout, annotated.jpg\|In contrast, '''pseudogout''' (Calcium pyrophosphate dihydrate crystal deposition disease) displays rhombus-shaped crystals with negative birefringence.
	</gallery>		</gallery>
	{{Bottom}}		{{Bottom}}

Mikael Häggström: Modified

2020-09-28T17:24:28Z

Modified

← Older revision		Revision as of 13:24, 28 September 2020
Line 4:		Line 4:
	}}		}}
	==Preparation==		==Preparation==
	A tophus specimen should be sent '''dry''' to the pathology department, and '''not''' be put in formalin.<ref group=notes>Formalin dissolves the crystals.</ref> A touch prep can be done initially, and at least if urate crystals ~~remain suspected~~, the specimen is submitted in 100% alcohol for microscopy evaluation.		A tophus specimen should be sent '''dry''' to the pathology department, and '''not''' be put in formalin.<ref group=notes name=dissolves>Formalin dissolves the crystals.</ref> A touch prep can be done initially, and at least if urate crystals are not initially detected, the specimen is submitted in 100% alcohol for microscopy evaluation.<ref group=notes name=dissolves/>

	==Microscopy evaluation==		==Microscopy evaluation==
	~~Evaluation of a fresh tophus can start as~~ a touch prep to look for needle-shaped crystals of urate. On polarized light, these will have negative birefriengence.		On a touch prep, look for needle-shaped crystals of urate. On polarized light, these will have negative birefriengence.
	<gallery mode=packed>		<gallery mode=packed>
	File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle shaped crystals		File:Light microscopy of a touch preparation of a gout tophus, showing urate crystals.jpg\|thumb\|Light microscopy of a touch preparation of a gout tophus, showing needle shaped crystals