Case report: diagnosis of gouty tophi on fine needle aspiration cytology

Fine needle aspiration cytology (FNAC) is an important diagnostic tool in the diagnosis of soft tissue nodules around joint. Our patient was a 55 year old man a known hypertensive, diabetic with history of multiple skin coloured nodular lesions on both feet involving ankle, malleoli, Achilles tendon and dorsum of the forth toe associated with discharging sinuses since two years. He did not have any other clinical symptoms. The X ray of both feet showed osteolytic lesions. FNAC of the lesions revealed, monosodium urate crystals (MSU) which are birefringent needle shaped crystals under polarising microscopy. Diagnosis on FNAC was given as gouty tophi. Further investigations done revealed high levels of serum uric acid (10.4mg %) and a confirmed diagnosis of gout was given. It is important that pathologist should be conversant with the cytomorphological features of gout and also should be aware that FNAC can play an important role in the diagnosis of these lesions.