痛风的临床病理特征分析并文献复习

目的:总结痛风临床病理特点。方法:回顾性分析1例痛风患者的生化机制、临床病理特征、刚果红染色、PAS染色特点、鉴别诊断要点,并复习相关文献。结果:患者主要临床表现为间断性多关节肿痛3年,加重伴发热3个月。体格检查发现患者有多发性皮下结节、多关节肿胀压痛。左腕、左肘皮下结节活检,经HE染色后光镜查见大量肉芽肿性病变,有的多核巨细胞内查见被吞噬的异物,有的病灶尚查见呈均质状物(尿酸盐结晶),其周围有较多异物巨细胞及纤维结缔组织包绕呈结节状,在结节的周边纤维血管周围可查见残留分化成熟的淋巴细胞及少数嗜酸性粒细胞。刚果红、PAS染色均为阴性。偏光显微镜下,刚果红未查见绿色强折光晶体,但见多量略呈淡黄色具有强折光性的晶体呈棒状或梭形。结论:痛风在刚果红染色偏光显微镜下观察呈淡黄色梭形或针状结晶,具有强折光性晶体,但这是否是痛风在刚果红染色的特征尚有待于进一步研究。

Analysis of the Clinicopathologic Features of Gout and Literature Review

Objective:To study the clinicopathologic characteristics of gout.Methods:The pathogenesis mechanism, clinical manifestations, histological features, Congo red staining and Periodic Acid Schiff (PAS) staining results of a patient suffering fromgout were analyzed, with review of the related literatures.Results:A 18-year-old young man complained that multiple joints swelling and pain discontinuity more than 3 years, aggravating associated with fever for 3 months. Physical examination showed that there were many subcutaneous nodules and multiple joints were painful swellings on pressure. The patient was taken to the operating room for excisional biopsy of left wrist and elbow subcutaneous nodules. Stained with Hematoxylin and eosin (H&E), we found multiple granulomatous diseases and foreign bodies in some multinucleated giant cells by microscopic. We also saw homogeneous materials that were monosodium urate monohydrate (MSU) crystals in some focus with a surrounding foreign body giant cells and fibrous connective tissue consistent with gout. Around the nodules, there were fibrovascular tissue surrounding by a few neutrophils and residual mature differentiation lymphocytes. Congo red staining and Periodic Acid Schiff (PAS) staining were all negative. However, we found many pale yellow crystals with strong birefringent under microplariscope by Congo red staining. The crystals presented clavate or fusiform.Conclusion:Gout has many pale yellow crystals with strong birefringent under microplariscope by Congo red staining. Whether it is characteristic pathological changes by Congo red staining in gout, there is no report about it up to now.We will collect more and hope more attention to it fromfellows.