Cytological diagnosis of gouty tophi over the elbow as an initial manifestation in an asymptomatic patient

Abstract

Abstract Fine needle aspiration (FNA) cytology (FNAC) is becoming the preferred diagnostic method over biopsy to diagnose periarticular nodules. A 56-year-old male patient presented with a solitary soft-tissue nodule surrounding the right elbow. There was no associated joint pain, swelling, deformity, or history of trauma in the past. Soft-tissue neoplasm was taken into consideration clinically. The chalky white aspirate was obtained by FNA, and needle-shaped crystals seen in amorphous granular debris were visible on smears, under the light microscope with condenser down. The needle-shaped crystals are the characteristic feature of monosodium urate crystals A gouty tophi diagnosis was made on cytology. Following that, further investigations were performed including serum uric acid level and X-ray, which were normal. Pathologists should be knowledgeable about the cytological characteristics of gouty tophi as FNAC is a useful diagnostic tool for the diagnosis of periarticular nodules, particularly in cases of unusual presentation.