Aspiration cytology of rheumatoid nodulosis: Diagnostic method of choice

Abstract

Rheumatoid nodules occur as an extraarticular manifestation of rheumatoid disease. Generally they are diagnosed by histology and seldom by fine needle aspiration (FNA). To our knowledge only two papers have described the cytologic characteristics of rheumatoid nodule.1,2 Below we describe our experience with FNA in a case of rheumatoid nodulosis. A 35-year-old man presented with multiple subcutaneous nodules on a heel, a knee and the hands, present for three years. They had gradually increased in size and number. They measured 1.0-2.5 cm in diameter, were nontender and firm, and had smooth surfaces. Investigations performed included hemogram, erythrocyte sedimentation rate, routine urinalysis, creatinine, uric acid, cholesterol, triglyceride and chest radiograph; all were noncontributory except for rheumatoid factor, which was positive. Roentgenograms of relevant joints were normal. The possibility of rheumatoid nodules was considered. FNA was advised to confirm the nature of the nodules. Since the patient had no history of arthritis, FNA was performed on nodules on a hand and heel with a 23-gauge needle. Smears prepared from the aspirate were air dried and stained with May-Gr\ufcnwald-Giemsa stain. The smears revealed the typical picture of a rheumatoid nodule: necrotic background material, lymphocytes, plasma cells, histiocytes (some giant and multinucleated) and elongated, large mesenchymal cells, probably elongated histiocytes