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Presented by Jonathan Epstein, M.D. and prepared by Jospeh Kronz, M.D.
Case 4: 71-year-old male with knee pain
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1. Question
Week 2: Case 4
71-year-old male with knee pain
Correct
Answer: Chondrocalcinosis
Histology: Polypoid fragments of dense fibrous tissue lined by synovium contain intensely basophilic irregular deposits of calcification. At higher magnification within the basophilic regions, there are numerous needle-shaped crystalline structures, which can be highlighted when polarized. Another name for chondrocalcinosis is pseudogout.
Discussion: When fixed in formalin, gout appears as amorphous lightly eosinophilic material which elicits a prominent multinucleated giant cell reaction. Calcification may occur within gout secondarily. If tissues involved by gout are fixed in absolute ethanol, sharply demarcated aggregates of needle shaped urate crystals lying in bundles can be visualized. Ochronosis when stained with H&E has a distinctive yellow-brown color; the pigment is deposited within collagen bundles, which often fragment and degenerate forming clumps. It does not elicit a foreign body giant cell reaction. Dystrophic calcification lacks crystalline structures.
Incorrect
Answer: Chondrocalcinosis
Histology: Polypoid fragments of dense fibrous tissue lined by synovium contain intensely basophilic irregular deposits of calcification. At higher magnification within the basophilic regions, there are numerous needle-shaped crystalline structures, which can be highlighted when polarized. Another name for chondrocalcinosis is pseudogout.
Discussion: When fixed in formalin, gout appears as amorphous lightly eosinophilic material which elicits a prominent multinucleated giant cell reaction. Calcification may occur within gout secondarily. If tissues involved by gout are fixed in absolute ethanol, sharply demarcated aggregates of needle shaped urate crystals lying in bundles can be visualized. Ochronosis when stained with H&E has a distinctive yellow-brown color; the pigment is deposited within collagen bundles, which often fragment and degenerate forming clumps. It does not elicit a foreign body giant cell reaction. Dystrophic calcification lacks crystalline structures.
