Cell Tumor Of Tendon Sheath Research Articles

Intense Lubricin Expression Defines Synoviocyte Differentiation and Detects Cells in Synovium‐Related and Myxoid Tumors

Immunoprofiles of synovium-related tumors, such as Giant Cell Tumor of Tendon Sheath (GCTTS), are incompletely explored, partly due to lack of lineage defining synoviocyte markers. Synovial lining is comprised of intimal macrophages and fibroblast-like synoviocytes (FLS). FLS produce lubricin, a mucin-like glycoprotein in synovial fluid. Lubricin expression in synovium, GCTTS and myxomas was assessed by immunohistochemistry using two anti-lubricin antibodies: S6.79, monoclonal antibody, raised against purified, native lubricin, and Ab28484, an affinity purified polyclonal antibody made against a C-terminal peptide. In synovium, lubricin reactivity was limited to intimal synoviocytes with cytoplasmic and surface lining staining Double staining using Ab28484 and anti-CD163, a marker of synovial intimal macrophages, showed non-overlap between the two synoviocyte types. In GCTTS, lubricin cytoplasmic expression was limited to large, plump cells, but not giant cells or smaller mononuclear cells Double staining showed lubricin positive cells were CD163 negative. Scattered mononuclear cells negative for both lubricin and CD163were present. A case of juxta-articular myxoma with extensive ganglion cyst-like areas showed moderate staining of myxoid stroma and intense staining of cyst lining using S6.79. A tumor of uncertain lineage showed reactivity, suggesting relatedness to FLS. Thus, lubricin expression defines cells within synovium-related and myxoid tumors.

Giant cell tumour of tendon sheath with bone invasion in extremities: analysis of clinical and imaging findings.

The purpose of this study was to review the clinical and imaging characteristics of giant cell tumour of tendon sheath (GCTTS) with bone invasion. Radiography (n = 9), magnetic resonance imaging (MRI) (n = 7), computed tomography (CT) (n = 4) and clinical findings of nine patients with surgically and pathologically confirmed GCTTS with bone invasion were retrospectively reviewed. Specific imaging findings including tumour site, maximum tumour size, shape, margin, density or signal intensity, bone invasion, periosteal reaction, calcification, and cystic areas were documented. There were five males and four females, with median age of 34 years. Presenting symptoms were painless mass in five patients, painful mass in two, intermittent pain and swelling in one and pain without mass in one. Five tumours were in the ankle-foot region, two in the hand, one in the cubital fossa and one in the patellofemoral joint. The total symptom duration ranged from 5 months to 6 years (median 12 months). The maximum tumour size ranged from 1.0 to 6.8 cm (median 3.0 cm). Radiographically, all tumours appeared as cortical destruction with well-defined margins. Four patients underwent CT scanning that clearly showed an iso-attenuated mass with intraosseous soft tissue. MR scanning was performed in seven patients who demonstrated a round, oval, spindle-shaped or multilobular soft tissue mass near or inside the joint with cortical destruction and intraosseous soft tissue. Five lesions were homogeneous moderate signal on T1WI. Moderate (n = 1), slightly high or high (n = 2) and low (n = 2) signal intensities were evident on T2WI. Two lesions showed heterogeneous low-to-moderate signal intensities on T1WI and mixed low signal intensities on T2WI. GCTTS is a benign soft tissue mass that may present as an intraosseous lesion near extremity joints and frequently occurring in foot and hand on radiological examinations. GCTTS with bone invasion should be considered when MRI shows solid mass with characteristic low signal on T2-weighted images.

Giant cell tumor of tendon sheath.

Giant cell tumor of tendon sheath (GCTTS) is often thought of as a volar finger mass. We hypothesized that GCTTS are equally common on the dorsal and volar aspects of the hand. In addition, we hypothesized that there are no factors associated with the location (volar versus dorsal) and largest measured dimension of a GCTTS. A total of 126 patients with a pathological diagnosis of a GCTTS of the hand or finger were reviewed. Basic demographic and GCTTS specific information was obtained. Bivariable analyses were used to assess predicting factors for location (volar or dorsal side) and largest measured diameter of a GCTTS. Seventy-two tumors (57%) were on the volar side of the hand, 47 (37%) were dorsal, 6 (4.8%) were both dorsal and volar, and one was midaxial (0.79%). The most common site of a GCTTS was the index finger (30%). There were no factors significantly associated with the location (volar or dorsal, n=119) of the GCTTS. There were also no factors significantly associated with a larger diameter of a GCTTS. A GCTTS was more frequently seen on the volar aspect of the hand. No significant factors associated with the location or an increased size of a GCTTS were found in this study.

Comparison of Ultrasonography and Magnetic Resonance Imaging for Diagnosis of Soft Tissue Masses of the Hand and Wrist

The purpose of this study is to evaluate the preoperative features and predict the preoperative diagnosis of hand and wrist soft tissue masses by ultrasonography and magnetic resonance imaging and compare the results with the postoperative pathological results. 14 patients with the complaint of mass or pain in their hand and wrist were included. Before the operation we practised ultrasonography and magnetic resonance imaging to the patients. The preoperative diagnosis were compared with postoperative pathological diagnosis. 14 patients (female/male: 10/4) were included. The pathological results were glomus tumor in 2, giant cell tumor of tendon sheath in 4, ganglion cyst in 4, schwannoma in 2, lipoma in 1 and fibroma in 1. According to these pathological results ultrasonography was 64 % (9/14) successful and magnetic resonance imaging was 50% (7/14) successful to predict all of the masses. High resolution ultrasonography is well suited for screening soft tissue masses because of its safety, low cost and real-time dynamic imaging. Sonography enables a reliable diagnosis of the cystic or solid nature of soft tissue lesions, accurate estimation of the volume and even presume the pathologic diagnosis according to the lesions. Ultrasonography may usually be adequate solely for the evaluation of soft tissues masses of hand and wrist.

Intra-articular nodular fasciitis: an unexpected diagnosis for a joint lesion: a case report.

Pathological lesions in and around a joint can arise from underlying dermis, subcutis, deep muscle, bone or synovium. Clinical presentation can include joint pain, joint swelling, palpable masses and mechanical restriction. Whilst giant cell tumour of tendon sheath, pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, juxta articular myxomas and inflammatory arthritis are the better-known conditions of the joint. Intra-articular nodular fasciitis, on the other hand, is less well recognized both clinically and radiologically. It is rarely seen in routine practice and is only described in case reports in the literature. Due to the non-specific clinical and radiological findings as well as the unfamiliarity with the entity, the diagnosis of intra-articular nodular fasciitis is usually clinched only after histological examination. We present a case of intra-articular nodular fasciitis arising in the knee joint which was not suspected clinically or radiologically. Intra-articular, nodular fasciitis, joint, knee, MRI.

Giant cell tumor of tendon sheath: a multicentric presentation

Giant cell tumor of the tendon sheath (GCTTS) is a relatively common soft tissue neoplasm arising from the tendon sheaths of upper and lower extremities. However, the incidence of GCTTS at multiple sites is not yet reported in literature which is extremely rare. Here we are reporting a case of a 21 year female presenting with slow growing, firm swellings on bilateral elbow and tendoachilis region. Fine needle aspiration was done from all the sites which revealed the features of GCTTS. This case highlights the unusual multicentric presentation of GCTTS.

Excisional biopsy of suspected benign soft tissue tumors of the upper extremity: correlation between preoperative diagnosis and actual pathology.

Tumors of the upper extremity are common and mostly benign. However, the prevalence of discordant diagnosis of a solid hand tumor is less studied. The objectives of this retrospective study were (1) to determine the proportion of patients with a different (discrepant or discordant) pathological diagnosis compared to the preoperative diagnosis, (2) to determine the prevalence of the types of pathologies encountered at excisional biopsy for suspected benign tumors, and (3) to determine the types of tumors diagnosed when the surgeon does not make a preoperative diagnosis. One hundred and eighty-two suspected benign soft tissue tumors of the upper extremity with a preoperative diagnosis other than ganglion cyst were excised by one of three surgeons over a 10-year period. A preoperative diagnosis was applied for 125 tumors. No preoperative imaging was used. Only 26 of the 125 tumors (21%) with a preoperative diagnosis were discrepant. The tumors that were most likely to have a discrepant diagnosis were vascular tumors (32%) and other less common benign tumors (33%). Among the entire cohort of 182 tumors, lipomas (19%), giant cell tumors of tendon sheath (GCTTS; 19%), and vascular tumors (16%) were the most frequent pathological diagnoses. Among the 57 tumors that did not have a preoperative diagnosis, most were vascular tumors (23%), fibromas (14%), and GCTTS (11%). One tumor without a preoperative diagnosis was a malignant tumor, but we consider this unusual and possibly spurious. A hand surgeon's preoperative diagnosis without imaging is usually correct prior to excision of a mass in the hand. Discrepant diagnoses are usually benign and do not alter treatment. Prognostic II.

Neglected Ruptured Flexor Carpi Ulnaris Tendon Mimics a Soft Tissue Tumor in the Wrist

A wrist mass is rarely caused by a ruptured tendon in the forearm. The common pathologies are ganglia, tendon tenosynovitis, and giant cell tumors of tendon sheaths. Less common causes are nerve sheath tumors, vascular lesions, or an accessory muscle belly. The authors investigated a case of neglected ruptured flexor carpi ulnaris tendon that mimics a mass in the wrist. To the authors' knowledge, this is the first case report in relevant literature. During investigation, the high-resolution musculoskeletal ultrasound suggested a soft tissue tumor or a ruptured flexor carpi ulnaris tendon. The magnetic resonance imaging scan indicated an accessory flexor carpi ulnaris muscle belly. The diagnosis of ruptured flexor carpi ulnaris tendon was confirmed by surgical exploration. This case indicates that ultrasound may be better suited than magnetic resonance imaging in evaluating a wrist mass for its accuracy, availability, and portability.

Pitfalls in Ultrasonography of Soft Tissue Tumors

Ultrasonography is increasingly the first-line investigation for the assessment of soft tissue masses. With increasing experience, most soft tissues masses, particularly superficial soft tissue masses, can be specifically labeled based on their ultrasonographic appearances. This diagnosis is based on a conundrum of clinical and ultrasonographic findings rather than resting on a single sign alone. One should try to minimize labeling the ultrasonographic appearances as "nonspecific" because this adds little to what is already known. Putting a specific label on a soft tissue mass such as a lipoma, nerve sheath tumor, or giant cell tumor of tendon sheath minimizes the need for percutaneous biopsy, greatly enhances clinical efficiency with regard to discussions on management and outcome, as well as immediately reduces patient anxiety with regard to the presence of malignancy. This article addresses the general approach to ultrasonography of soft issue masses, highlighting in particular the common pitfalls encountered in their diagnosis.

Tuberculous Tenosynovitis Presenting As Ganglion Of Wrist

Tuberculosis (TB) is still endemic in many developed countries. Involvement of the hand and wrist at presentation is extremely rare, and the diagnosis is often missed. 57 years old male presented with swelling over the left wrist since 3 years. Three swellings over dorsal aspect of the left wrist, soft in consistency, non tender, non compressible mobile at right angles to the plane of the wrist joint. ESR: 45 mm in 1 hr and rest blood investigation were normal. Ultrasonography showed Giant-cell tumor of Extensor Digitorum sheath. Xray: soft tissue swelling MRI suggestive of Extensor Tendon sheath Extraskeletal Synovial Koch’s or Giant cell tumor of tendon sheath. Then planed for excision of swelling and intra-operative fi nding were rice bodies. Histopathological examination showed caseous necrosis with granuloma formation. Patient put on DOT1 therapy. Tuberculous tenosynovitis was first described by Acrel in 1777. Rice bodies occurring in joints affected by tuberculosis were first described in 1895 by Reise Rice bodies will be diagnosed on plain radiographs when mineralization occurs. More than 50% of cases recur within 1 year of treatment. The currently recommended 6-month course is often adequate with Extensive curettage, lavage and synovectomy should be performed. Surgery is essential, but the extent of surgical debridement is still debatable. The surgeon has to be aware of the significance of loose bodies when performing routine excision of innocuous looking wrist ganglia. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2013; X(2); 45-47 DOI: http://dx.doi.org/10.3126/saarctb.v10i2.9713

Bilateral giant cell tumor of tendon sheath of tendoachilles

Giant cell tumor of tendon sheath arises from the synovium of tendon sheaths, joints, or bursae, mostly affects adults between 30 and 50 years of age, and is slightly more common in females. We report the case of a 32-years-old male presenting with pain in both ankles without any history of trauma. On clinical examination, tenderness on both tendoachilles and local thickening were observed. Ultrasonography showed thickening of local tendinous area with increase in anteroposterior diameter, and Doppler demonstrated increased flow in peritendinous area. MRI findings showed that most of the tumor had intermediate signal intensity and portions of the tumor had low signal intensity. Fine needle aspiration cytology confirmed the diagnosis of giant cell tumor of tendon sheath. Excision biopsy was done with no recurrence on five month follow-up. Review of literature did not reveal any similar result; so, bilateral giant cell tumor of tendon sheath of tendoachilles is a rare presentation.

Giant Cell Tumour of Tendon Sheath in Thumb—A Case Report

Giant cell tumor of the tendon sheath is the second most common tumor of the hand often referred to as xanthoma. Histologically these tumors are composed of multinucleated giant cells, polyhedral histiocytes, fibrosis and hemosiderin deposits. Marginal excision of giant cell tumor of the tendon sheath is the treatment of choice. We present a case of xanthoma of flexor pollicis longus tendon presented as a single enlarging mass in volar aspect of left thumb. After clinical diagnosis, work-up is done with ultrasound, FNAC and excision biopsy.

Giant Cell Tumour of the Tendon Sheath: Analysis of 35 Cases and their Ki-67 Proliferation Indexes.

A giant cell Tumour of the tendon sheath (GCTTS) is a slow-growing benign Tumour originating from the synovial cells of the tendon sheath. It is the second most common Tumour of the hand. The aim of this study was to perform a retrospective clinicopathological evaluation of GCTTS cases and determine whether the proliferative activity of giant cell tumour of tendon sheath is related to its recurrence rate and local aggressiveness. The age, gender, Tumour location and diameter, treatment mode, Ki-67 proliferation index, mitotic rate, and recurrence were retrospectively evaluated in 35 patients diagnosed with GCTTS in the Department of Pathology, School of Medicine, Recep Tayyip Erdogan University between 2009 and 2014. Of the 35 GCTTS cases, 23 were female, and 12 were male. The mean age was 45 y (range 10-70). Sixteen tumours were located in the right hand and 14 in the left hand, and five were in the feet. The mean Tumour diameter was 2.3 cm (0.6-6 cm). All patients underwent marginal excision. The mean postoperative follow-up period was 4 y (range 28 months-5 y). Only six patients showed recurrence. In these cases, the site of GCTTS recurrence was the phalanx of the hand. The mean Ki-67 index in the recurrence cases was 6.5%, whereas it was 2.3% in those without recurrence. The Ki-67 proliferation index and mitotic activity were increased in recurrent cases compared to nonrecurrent cases. Therefore, these parameters may be helpful in predicting recurrence of GCTTS. However, adequate surgical excision and complete removal of the Tumour are important steps to minimize the recurrence rate.

A Case Series of Various Swelling of Fingers in Adults

Patients commonly present to their general practitioner with swellings of the hand. These include a variety of diagnoses with certain lesions (for example, ganglion) being more common than others. Some may even be familiar as they are often site-specific. This article aims to provide general practitioners with clear and concise information regarding swellings to be ruled out before suspecting giant cell tumor of tendon sheath. Swellings of the hand are commonly encountered in a general practice with different diagnosis. They may arise from any tissue in the hand including skin, subcutaneous fat, muscle, nerves, vessels, tendon, bone and cartilage. Fortunately, most are benign, asymptomatic and may not require surgical intervention. Ganglions, epidermoid inclusion cysts, giant cell tumours of the tendon sheath, and swellings associated with arthropathy comprise the majority of lesion. This study includes 16 cases which are presented with similar history and presentation of finger swellings as that of giant cell tumor tendon sheath but the final diagnosis has varied.

Multiple giant cell tumours of tendon sheath: a rare occurrence.

Giant Cell Tumours Of Tendon Sheath (GCTTS) are the second most frequent soft tissue tumours affecting the hand with an overall incidence of 1 in 50,000 individuals. These tumours are usually localized and solitary, with multiple GCTTS occurring rarely. Multi-centric origin is considered unusual and very few cases of multiple GCTTS have been reported till date. Here, we report a rare case of a 26-year-old female who presented with multiple painless swellings on palmar aspect of little finger of right hand since six months. Clinical diagnosis of Dupuytren's contracture was given. Intraoperative examination revealed multiple separate nodules, firmly attached to the flexor tendon synovial sheath. Histopathology showed features of GCTTS.

English

INTRODUCTION: Giant cell tumours of the tendon sheath are the second commonest tumours of the hand after ganglion cysts. Usually they involve volar aspect of the proximal interphalangeal joint of fingers. Here is a case where dorsal aspect of the distal interphalangeal joint of the middle finger is involved which is a rare presentation. CASE DETAILS: 47 yrs male patient came with swelling in the middle finger of left hand since two years, examination of it reveals 2.5x2 cm firm lobulated swelling adherent to underlying tissues, skin over it is free from the swelling. X- ray examination reveals rounded soft tissue shadow with erosion of the dorsal surface and radial border of the distal phalanx. It was treated with marginal excision of the tumour and a part of tendon sheath. Histopathological examination confirms the diagnosis of giant cell tumour of the tendon sheath. CONCLUSION: Giant cell tumour of tendon sheath involving the dorsal aspect of the distal interphalangeal joint of the fingers is rare. Radiologically it produces bone erosion. Involving the dorsal aspect, distal interphalangeal joint and erosion of bone in X-ray are the factors for the high recurrence rate. Surgical marginal excision is the treatment of choice.

Cellular cannibalism in central and peripheral giant cell granuloma of the oral cavity can predict biological behavior of the lesion

Cancer cannibalism is used to differentiate benign tumors from malignant, but recently the phenomenon has been demonstrated in giant cell tumor of tendon sheath (localized type). Microscopically and pathogenetically, this tumor is similar to central giant cell granuloma (CGCG) and peripheral giant cell granuloma (PGCG) of oral cavity. Hence, attempt has been made to study the cannibalistic giant cells (GCs) in CGCG and PGCG with their correlation with the biological behavior. Surgically treated 16 CGCG and 23 PGCG cases with adequate clinical and radiographic documentation were selected. Quantification of cannibalistic GCs was performed using routine HE stain. Hundred GCs were examined in each section, and number of cannibalistic cells was expressed in percentage. Ten cases were randomly selected for further immunohistochemical analysis with CD68 and bcl-2. Cannibalism was found in all the cases (100%). The frequency of occurrence of cannibalistic GCs ranged from 20% to 56% with a mean of 33.62 ± 8.9. CGCG showed significantly higher mean cannibalistic GC frequency (38.06 ± 10.15) than PGCG (30.04 ± 5.63). In aggressive CGCG, mean cannibalistic GC frequency was significantly higher (42.20 ± 10.4) than non-aggressive type (31.17 ± 6.014). Similarly, recurrent cases showed significantly higher mean cannibalistic cell frequency (43 ± 6.26) than non-recurrent cases (30.81 ± 6.66). Immunohistochemistry results showed histiocytic nature of GCs as well as mononuclear cells. The internalized cells did not expressed bcl-2, suggesting that the internalization induces apoptotic cell death. Assessment of frequency of cannibalistic cells in CGCG and PCGC could help in predicting the biological behavior of the tumor.

Toe Deformity after Pregnancy due to Fibroma of Tendon Sheath: A Case Report and Review of Literature

Toe Deformity after Pregnancy due to Fibroma of Tendon Sheath: A Case Report and Review of Literature

English

Introduction Tendon abnormalities are common musculoskeletal disorders. Accurate and timely diagnosis of tendon abnormalities is essential to ensure proper treatment and to prevent tendon disability. The purpose of this critical article is to describe the sonographic characteristic of different tendon abnormalities. Material and methods A retrospective review of ultrasonography images of patients with different tendon abnormalities was conducted and the results of analysis were compared with the published literature data. Results The study included 149 patients (105 male patients, 44 female patients), with average age of 47.4 ± 16, with 157 affected tendons. The most affected tendon in our patients was supraspinatus tendon, followed by Achilles tendon and patellar ligament. Dominant pathologic finding was tendinosis in 83 cases, with chronic tendinosis to be more frequent. Partial-thickness tear was detected in 35 cases, the most common occurred in supraspinatus tendon. Full-thickness tear was revealed in 11 patients, with Achilles tendon being the most common. Tenosynovitis was diagnosed in 18 cases. In 8 of 13 cases, tenosynovitis of long head of the biceps tendon was associated with abnormalities of the supraspinatus tendon. In five cases, tenosynovitis of wrist and hand tendons was detected. Tendon tumour was detected in 10 patients, seven ganglion cysts and three giant cell tumours of tendon sheath. Results of our study are similar to those in the published literature data. Discussion Musculoskeletal sonography is well suited for evaluating tendons. In most cases, its accuracy is at least equivalent to that of magnetic resonance imaging for imaging tendon abnormalities. But the advantages of sonography, such as accessibility, low cost, dynamic capability and needle guidance make it as a first-line imaging technique in tendons evaluation. Although operator dependence is an often quoted disadvantage of sonography, experienced musculoskeletal radiologists can perform effective tendon evaluation and quickly detect the abnormality. Conclusion Ultrasound is an efficient and accurate imaging method for evaluation of tendon abnormalities. Like magnetic resonance imaging, ultrasonography is a technique that affords anatomic images in multiple planes and that may provide information about tissue characterisation.

Cytodiagnosis of gouty tophus

To the Editor, Periarticular nodule can prove to be a challenge to both clinicians and pathologists. It covers inflammatory to neoplastic conditions ranging from rheumatoid nodule, gout, giant cell tumor of tendon sheath, synovial osteochondromatosis to synovial sarcoma.[1] Amongst these, gouty tophus is an important differential. Fine Needle Aspiration Cytology (FNAC) is becoming popular in diagnosis of soft tissue nodules; hence it is important for the pathologists to be aware of its varied microscopic features. Here, we present clinical and cytological profile of a case of gouty tophus.[1,2] A 62 year male presented with swelling over left middle toe of 6 months duration. It was painful and gradually increasing in size. On examination it measured 2 cm × 1 cm, immobile, firm to hard, tender with tense overlying skin [Figure 1]. Patient gave a past history of nephrolithiasis about 8 years back for which he was treated. On investigations, his Erythrocyte sedimentation rate (ESR) was 36 mm at the end of 1 h. His hemogram, liver function tests, serum calcium level and rheumatoid factor were within the normal limits. Blood urea was 98 mg/dl, serum creatinine 3.1 mg/dl and serum uric acid 9.1 mg/dl. Radiograph of the lesion showed a soft-tissue swelling without involvement of underlying bone with no evidence of calcification. FNA from the swelling, yielded whitish, and granular material. Smears prepared were wet fixed in 95% ethanol and some were also air dried. The wet fixed smears were stained with H and E and Papanicolaou stains. The air dried smears were stained with May Grunwald Giemsa stain (MGG). Smears revealed amorphous crystalline material intermingled with which were few histiocytes and foreign body giant cells [Figure 2]. The crystalline material on the higher magnification particularly with MGG revealed elongated needle shaped crystals with pointed ends [Figure 3]. The diagnosis of gouty tophus was made on the cytology, which was further supported by elevated levels of serum uric acid. Smears were not examined under polarized microscope as this facility was unavailable. Being a medically treatable condition, excision of the mass was not done and the clinicians directly put the patient on the anti-uric acid drugs. Figure 1 Nodular swelling 2 × 1 × 1 cm in size, firm, immobile, non-tender, with tense overlying skin Figure 2 Amorphous granular material and foreign body giant cell (Papanicolaou ×20) (Inset showing elongated crystals MGG x20) Figure 3 Elongated needle shaped crystals with pointed tips (MGG × 40) FNAC is an easy alternative to synovial biopsy and joint fluid analysis in a case of gouty tophus.[3] Whenever an aspiration yields amorphous or granular material, the cytopathologists should carefully search for characteristic crystals especially in MGG. Although gouty tophus presents classic histological features, definitive diagnosis relies on the demonstration of crystals which are often dissolved in routine tissue processing.[3] However, these crystals are excellently preserved and demonstrated in air dried smears stained with MGG. These monosodium urate crystals are needle shaped rods about 5-20 u in length with pointed tips. They are also strongly birefringent.[4] On histology, gouty tophus shows large amorphous aggregates of urate crystals surrounded by intense inflammatory cells macrophages, lymphocytes, foreign body giant cells, and fibroblastic reaction. However, the morphology of individual crystals cannot be appreciated well. The tissue diagnosis can be of additional help to demonstrate birefringence if this ancillary technique is available.[5,6] FNAC offers a simple, cost effective tool in elucidating the nature of periarticular nodule.[1,3,4] In case of gouty tophus, it also has an added advantage of excellent preservation of crystals. Thus, if a pathologist is aware of its morphology, further unnecessary investigations can be avoided. Patient was subsequently puts on the antiuric acid drugs. After a period of 3 months, swelling reduced remarkably in size and uric acid level decreased to 4.6 mg/dl.