Gouty Tophi in Lumbar Region that Mimicked Chondrosarcoma, a Case Report

Abstract

Aims: To report a case of tophaceous gout in the lumbar spine with atypical imaging presentation, mimicking a chondrosarcoma and to discuss the differential diagnosis, illustrate the pathological aspects and surgical management. Presentation of Case: A 40 years old hypertensive man presented with a two year history of progressive back pain, swelling on lumbar region and inability to walk by severe pain upon standing. Image studies showed a lumbar lesion with spongy calcifications and L4 pedicles destruction, We found consistent with the diagnosis of a chondrosarcoma. The patient had hyperuricemia. He underwent excision of the lesion. A trans-operative pathological study showed crystals, hemosiderophages and multinucleated giant cells, suggestive of a granulomatous lesion. On immunohistochemistry, the giant cells had positive immunoreaction to osteconectin, vimentin, CD68, fascin, IL1a, IL6, IL18 and TNFα. Gouty tophi was diagnosed. The patient improved after decompression, resection and instrumentation with transpedicular screws at L3, L5 and S1. Discussion: Due to the variability of clinical presentation and radiological appearance, some authors have designated gout as a great mimicker it may simulate soft tissue tumors, intra articular and bone tumors or metastatic disease. In the spine it has been misdiagnosed with tumors, tuberculosis or pyogenic discitis. Conclusion: Most cases of tophaceous gout of the spine have required surgical treatment for diagnosis, spinal cord and nerve roots decompression or correction of spinal instability when bone destruction is present.