PMC4891590_01
Axial A. T1-weighted image at the distal aspect of the mass and B. T2-weighted fat suppressed MR image at the mid portion of the mass (*) demonstrate similar signal intensity to adjacent muscle and a mild amount of adjacent edema (arrowheads). [Powerpoint Slide]
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Review of outside magnetic resonance (MR) imaging demonstrated a soft tissue mass adjacent to the medial epicondyle, which followed muscle signal intensity on all sequences (Fig. 1).
Axial T1-weighted fat suppressed MR image A. pre gadolinium shows the medially located mass (*) to be isointense to muscle (marker overlies mass) and B. post gadolinium shows enhancement of the mass (*) similar to adjacent muscle with a mild amount of enhancement in the adjacent fat (arrowheads). The patient moved slightly between sequences. [Powerpoint Slide]
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Enhancement of the mass was similar to adjacent muscle (Fig. 2).
Intraoperative photo A. and surgical specimen B. showing the excised rubbery, yellow-tan mass with adherent white chalk-like material. [Powerpoint Slide]
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A piece of thickened, rubbery, yellow-tan tissue measuring 2.1 x 1.2 x 0.9 cm was excised (Fig. 3).
Tophus on H&E stain. A. low power (40x magnification) and B. high power (200x magnification) demonstrating multinucleated giant cells and chronic inflammation. [Powerpoint Slide]
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The pathologic examination revealed urate crystal deposition with foreign body giant cell reaction and chronic inflammation in connective tissue, consistent with a gouty tophus (Fig. 4).