Endoscopic biopsy sampling of tophaceous gout of the odontoid process

Case report and review of the literature

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✓The authors present the case of a 71-year-old man who presented with neck pain, a history of gout, and a mass in the dens. Results of transoral endoscopic biopsy sampling demonstrated tophaceous gout. The patient was treated medically and the pain resolved. Tophaceous gout isolated in the dens is extremely rare and should be considered in the differential diagnosis of masses in this region. With the aid of transoral or transnasal endoscopic biopsy sampling, the diagnosis can be reached in a minimally invasive manner.

Abbreviation used in this paper:MR = magnetic resonance.

Article Information

Address reprint requests to: Theodore H. Schwartz, M.D., Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, 525 East 68th Street, Box #99, New York, New York 10021. email: schwarh@med.cornell.edu.

© AANS, except where prohibited by US copyright law.



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    Neuroimaging studies demonstrating a lytic lesion in the odontoid process. The lesion is shown on a computed tomography scan (A) and appears hypointense on both T1-weighted (B) and T2-weighted (C) MR images.

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    Endoscopic view of the lesion via the transoral approach demonstrating the limited exposure necessary to obtain an adequate biopsy sample.


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