50-year-old Anudatta, presents with enlarged knuckles and large subcutaneous nodules near her elbows. Her proximal interphalangeal (PIP) joints are hyperextended and her distal interphalangeal (DIP) joints are flexed. If the nodules were biopsied, which of the following would best describe their likely histological appearance?
Swan-neck deformity (PIP joints hyperextended and DIP joints flexed), enlarged knuckles, and subcutaneous nodules are classic clues for rheumatoid ahritis. The subcutaneous rheumatoid nodules are composed histologically of areas of fibrinoid necrosis surrounded by palisading epithelioid cells. Gout tophi are amorphous crystalline masses surrounded by macrophages. Ganglion cysts are small cystic spaces caused by myxoid degeneration of connective tissue. Pigmented villonodular synovitis causes darkly pigmented synovium with exuberant villous growth.
Amorphous crystalline mass surrounded by macrophages
Cystic space caused by myxoid degeneration of connective tissue
Darkly pigmented synovium with an exuberant, villous growth
Fibrinoid necrosis surrounded by palisading epithelioid cells