The Broad Spectrum of Urate Crystal Deposition: Unusual Presentations of Gouty Tophi

Forbess, Lindsy; Fields, Theodore

doi:10.1016/j.semarthrit.2012.03.007

Cited by 96 publications

(62 citation statements)

References 119 publications

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“…Urate crystals are known to precipitate in loci other than the joints when supersaturated with uric acid. Anecdotal tophi have been reported in many different organs,1 though prevalence data of individual crystals are lacking. Are such deposits exceptional, or are they the tip of a crystalline iceberg?…”

Section: Discussionmentioning

confidence: 99%

“…In fact, anecdotal observations of visible and/or palpable tophaceous deposits have been reported from many different organs,1 but they have usually been considered to be ‘medical oddities’ 2. Newer imaging modalities of ultrasound and dual-energy CT (DECT) have revealed far more extensive periarticular deposition than we previously suspected 3–5.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of birefringent crystals in cardiac and prostatic tissues, an observational study

et al. 2014

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IntroductionThe prevalence of urate crystals in residual tissue samples from coronary arteries, aortic valves and prostate glands was assessed.MethodsAlcohol-fixed coronary arteries from 55 explanted hearts, alcohol-fixed aortic valves collected from 75 valve replacement surgeries and 40 frozen, unfixed prostate specimens resected during cancer surgery were examined for birefringent crystals with polarising microscopy.ResultsIn the 55 explanted hearts, 6 (10.9%) contained a coronary artery with birefringent crystals. One of the 75 aortic valves (1.4%) contained negatively and positively birefringent crystals. Nineteen of the 40 (47.5%) prostates contained birefringent crystals.ConclusionsWe found that a remarkable percentage of coronary arteries and prostate specimens contained birefringent crystals. Crystal presence is an obvious prerequisite for possible crystal induced-inflammation in these tissues, just as similar crystals elicit a gouty inflammatory cascade in synovial joints. Further studies are necessary to determine whether urate crystals may play this role in these tissues and, if so, to establish whether urate-lowering therapy may be beneficial in prostatitis and coronary disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of birefringent crystals in cardiac and prostatic tissues, an observational study

et al. 2014

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“…Gouty tophi are known to have a wide range of unusual localisation in the body 3 4. There are only two case reports of pancreatic gout prior to our case, one mimicked pancreatic neoplasm and the other mimicked infection of a pancreatic pseudocyst 1 2.…”

Section: Discussionmentioning

confidence: 72%

“…Gouty tophi are also known to deposit in malignant tumours elsewhere in the body 3 4. Confident diagnosis of pancreatic gout is thus best achieved by excluding malignancy through tissue sampling and follow-up for complete resolution.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic gout and the role of multimodality imaging in its management

et al. 2016

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Uric acid deposition in the pancreas is very rare and neither an endoscopic ultrasound (EUS) nor a contrast-enhanced CT image of this condition has ever been published. We describe a case of asymptomatic pancreatic gout that was detected incidentally on CT. Imaging features mimicked pancreatic neoplasm, warranting further evaluation with EUS-guided fine-needle aspiration. Samples revealed debris encrusted with monosodium urate crystals. Follow-up CT showed complete resolution with urate-lowering therapy. We aim to augment current knowledge on the imaging of pancreatic gout and discuss its management.

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“…Patellar gouty tophus can be misdiagnosed as a bone tumor in roentgenogram or MRI scans. 10 The most common reported pathologies in patients younger than 40 years of age were chondroblastoma and giant cell tumor, while metastatic diseases and gout were the most common for patients over 40 years of age.…”

Section: Discussionmentioning

confidence: 99%