Lenz W, Klein W, Huth F
Beitr Pathol. 1976 Apr;157(2):161-82.
Radiological and morphological findings in advanced arthritis urica and pyrophosphate arthropathy are well known. In contrast, the early changes of synovial membrane in these disturbances of metabolism pose diagnostic problems. With the assistance of various cytological techniques and polarizing microscopical as well as electron microscopical investigation it was examined to what extent needle biopsies can be helpful in the differential diagnosis of gout and pseudogout.
In 8 patients with gout and 11 patients with pseudogout synovial fluid and small tissue specimens could be obtained with the aid of the Parker-Pearson needle. Both fluid and tissue specimens were investigated light and electron microscopically. Cell counts were evaluated in a Rosenthal chamber. The differentiation of the cells in stained smears was done by counting 200-600 cells per case. Crystals were identified by polarizing microscopy in wet preparations of freshly aspirated synovial fluid.
Polarizing microscopy of synovial fluid detected intra- as well as extracellular urate and pyrophosphate crystals. The wedge-shaped urate crystals and the larger partly polygonal pyrophosphate crystals showed different polarizing microscopical properties and a negative birefringence. The absolute cell counts in gout were higher than those in pseudogout. The relative cell counts of the different cell types in synovial fluid showed more variation in gout than in pseudogout. Cases with acute gout developed a relative leukocytosis in contrast to a relative lymphocytosis in chronic gout. A relative leukocytosis was constant in all patients with pseudogout. Sclerosed areas with scarce and plump villi as well as sometimes hyperplastic and polymorphous synovial cell layers could be demonstrated histologically in the tissue specimens of the needle biopsies in cases with gout. Urate crystals were less frequent in specimens fixed in formalin. The histological alterations in pseudogout were uniform, 2-4 rows of slightly pleomorphic synovial cells lined the inner surface of the joint capsule, sclerosing alterations were less frequent. Pyrophosphate crystals and calcified particles were seen within the synovial lining cells, the connective tissue and the enodthelial cells of the blood vessels in pseudogout specimens. Intra- as well as extracellular crystals could also be demonstrated with the aid of scanning electron microscopy in sediments of synovial fluid in gout and pseudogout. Transmission electron microscopical investigations of synovial tissue specimens detected proliferated and pleomorphic synovial lining cells in gout in contrast to a more monomorphic appearance of these cells in pseudogout. The crystals were washed out during the preparation techniques for transmission electron microscopy so that needle-like empty spaces resulted within cytoplasm of the phagocytic cells. These clefts were surrounded by phagosomal structures and densified cytoplasmic ground substance; sometimes they were also lined by membranes...
晚期痛风性关节炎和焦磷酸钙关节病的放射学和形态学表现已广为人知。相比之下，这些代谢紊乱中滑膜的早期变化存在诊断难题。借助各种细胞学技术、偏振显微镜以及电子显微镜检查，研究了针吸活检在痛风和假性痛风鉴别诊断中的帮助程度。
借助帕克 - 皮尔逊针，从8例痛风患者和11例假性痛风患者中获取了滑液和小组织标本。对液体和组织标本进行了光镜和电镜检查。在罗森塔尔计数板中评估细胞计数。通过对每例计数200 - 600个细胞来区分染色涂片上的细胞。通过偏振显微镜在新鲜抽取的滑液湿片中鉴定晶体。
滑液的偏振显微镜检查发现了细胞内和细胞外的尿酸盐和焦磷酸钙晶体。楔形尿酸盐晶体和较大的部分多边形焦磷酸钙晶体表现出不同的偏振显微镜特性和负双折射。痛风患者的绝对细胞计数高于假性痛风患者。滑液中不同细胞类型的相对细胞计数在痛风中比在假性痛风中变化更大。急性痛风患者出现相对白细胞增多，而慢性痛风患者则出现相对淋巴细胞增多。所有假性痛风患者均持续存在相对白细胞增多。在痛风患者针吸活检的组织标本中，组织学上可显示有绒毛稀少且饱满的硬化区域，以及有时增生且多形的滑膜细胞层。在福尔马林固定的标本中尿酸盐晶体较少见。假性痛风的组织学改变较为一致，关节囊内表面有2 - 4排轻度多形性滑膜细胞排列，硬化改变较少见。在假性痛风标本的滑膜衬里细胞、结缔组织和血管内皮细胞内可见焦磷酸钙晶体和钙化颗粒。借助扫描电子显微镜在痛风和假性痛风的滑液沉淀物中也可显示细胞内和细胞外晶体。滑膜组织标本的透射电子显微镜研究发现，痛风患者的滑膜衬里细胞增生且多形，而假性痛风患者的这些细胞外观更单一。在透射电子显微镜制备技术过程中晶体被冲洗掉，因此在吞噬细胞的细胞质内形成针状空隙。这些裂隙被吞噬体结构和致密的细胞质基质包围；有时它们也被膜覆盖……
