통풍성 관절염 환자에서 관절강 내 윤활액의 세포 소견 - 증례보고 2예 -
Cytology of Synovial Fluid in Gouty Arthritis - Two Cases Report -
김지영, 전이경, 장회숙, 김복만, 김희숙, 안재용, 홍성란,
소속 상세정보
김지영 ( Kim Ji-Young )
관동대학교 의과대학 제일병원 병리과
전이경 ( Chun Yi-Kyeong )
관동대학교 의과대학 제일병원 병리과
장회숙 ( Jang Hoi-Sook )
관동대학교 의과대학 제일병원 병리과
김복만 ( Kim Bok-Man )
관동대학교 의과대학 제일병원 병리과
김희숙 ( Kim Hy-Sook )
관동대학교 의과대학 제일병원 병리과
안재용 ( An Jae-Yong )
관동대학교 의과대학 제일병원 정형외과
홍성란 ( Hong Sung-Ran )
관동대학교 의과대학 제일병원 병리과
KMID : 0357920090430010092
Abstract
Synovial fluid (SF) aspiration cytology is a useful diagnostic tool. For patients with gouty arthritis, the diagnosis is confirmed by the presence of monosodium uric acid (MSU) crystals in the SF, and these crystals are long, pointed ended and needle-shaped and they show strongly negative birefringence. Sometimes, it is difficult to diagnosis between gouty arthritis and other type of inflammatory arthritis. We experienced two unusual cases of gouty arthritis that we performed SF analysis for. The first patient was a 35 year old male who presented with relatively typical clinical symptoms with hyperuricemia, but the SF showed acute inflammatory cells without crystals on light microscopy. Only a few suspected crystals of MSU were identified on polarizing microscopy. The second patient was a 45 year old male who presented with atypical symptoms and pain and swelling of the left ankle and knee joint for 3 weeks. The uric acid level in the serum and urine was increased, but not over the normal limit. However, on light and polarizing microscopy, there were numerous MSU crystals in the SF. Conclusively, in some cases of gouty arthritis, the crystals are not identified on light microscopy or the uric acid level is not dramatically increased. So, the polarizing microscopy, the clinical information and the laboratory findings are all included in the work-up when evaluating the SF cytology of arthritis patients.
키워드
Gout;Synovial fluid;Monosodium urate;Cytology
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