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This is a 46 year old man with a long standing history of chronic joint pain. He presents with a subcutaneous nodule over the left elbow.

Microscopic Findings

    Sections show palisading granulomas surrounding an amorphous eosinophilic to amphophilic staining debris.  
  Figure 1      


    Higher power reveals a fine crystals present within the eosinophilic center surrounded by epithelioid histiocytes and rare giant cells.  
  Figure 2      


    In other sections of the same biopsy, palisading necrobiotic granulomas are noted.  
  Figure 3      



On higher power, the eosinophilic center reveals areas of necrobiosis with rare nuclear dust and no evidence of crystals. No atypia of the epithelioid histiocytes is noted.

  Figure 4      

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Last Updated 1/21/2003

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