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Synovitis Pathology

Mucoid Change

Feature:

Represents sulfated proteoglycans and appears as gelatinous material around blood vessels and in the interstitium  (Appears as a bluish extracellular material, best seen in Harris H&E to be able to score)

Magnification: 4 – 5x

Grading:

  • 0: None (12%)
  • 1: Slight (41%):   Perivascular
  • 2: Moderate (27%):  Perivascular and interstitial
  • 3: Marked (12%):Widespread, may see myxomatous change, stellate cell
  • 4: Myxomatous (8%)

Grade 1 | Grade 2 | Grade 3 | Grade 4

Grade 1: The lowest degree of mucoid change appears around blood vessels with little extension beyond the vascular web.
Grade 2: With an increase in mucoid change, there is persisting perivascular accumulation that extends into the adjacent tissues in a patchy distribution.
Grade 3: The mucoid change in this grade becomes more widespread and, like interstitial fibrosis, tends to replace synovial fat and obliterate the synovial architecture.
Grade 4: Myxomatous mucoid change appears as a field of material that obliterates the synovial architecture and appears as cells (sometimes angular and stellate) suspended in amorphous, bluish matrix supported by delicate collagenous (pink) stroma. This imparts a jelly-like quality to the gross tissue.

Back to Pathology of Synovitis