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Rheumatoid arthritis mimicking metastatic squamous cell carcinoma.

Gomez-Rivera F, El-Naggar AK, Guha-Thakurta N, Kupferman ME - Head Neck Oncol (2011)

Bottom Line: Imaging demonstrated a 1.4 cm cystic lesion at the hyoid bone.A trans-cervical approach was used.Pathology revealed a necrotizing granuloma compatible with rheumatoid etiology.

View Article: PubMed Central - HTML - PubMed

Affiliation: Otorhinolaryngology - Head and Neck Surgery/Otolaryngology, The University of Houston Health Science Center, Houston, Texas, USA.

ABSTRACT
We report a case of a cervical rheumatoid nodule in close relation to the hyoid bone mimicking a metastatic carcinoma. A 74-year-old female with a 15-year history of rheumatoid arthritis (RA) on treatment with methotrexate presented with tenderness of the right base of tongue. Imaging demonstrated a 1.4 cm cystic lesion at the hyoid bone. Biopsies were unsuccessful and the patient required surgical resection of the mass. A trans-cervical approach was used. Pathology revealed a necrotizing granuloma compatible with rheumatoid etiology. The clinician should be aware that, in a patient with a neck mass, in the presence of active RA, rheumatoid nodules should be part of the differential diagnosis.

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Post contrast axial CT. Post contrast axial CT scan demonstrating a heterogeneous, well circumscribed lesion in the left pre-epiglottic space abutting the posterior surface of the hyoid bone at the junction of the body and the cornua.
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Figure 1: Post contrast axial CT. Post contrast axial CT scan demonstrating a heterogeneous, well circumscribed lesion in the left pre-epiglottic space abutting the posterior surface of the hyoid bone at the junction of the body and the cornua.

Mentions: A CT scan revealed a small, well-circumscribed, ovoid mass with central necrosis in the left pre-epiglottic space, abutting the posterior surface of the hyoid bone (Figure 1). Neither an ultrasound guided fine-needle aspiration biopsy, nor a core needle biopsy, despite multiple attempts, was successful in identifying the histology.


Rheumatoid arthritis mimicking metastatic squamous cell carcinoma.

Gomez-Rivera F, El-Naggar AK, Guha-Thakurta N, Kupferman ME - Head Neck Oncol (2011)

Post contrast axial CT. Post contrast axial CT scan demonstrating a heterogeneous, well circumscribed lesion in the left pre-epiglottic space abutting the posterior surface of the hyoid bone at the junction of the body and the cornua.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3118955&req=5

Figure 1: Post contrast axial CT. Post contrast axial CT scan demonstrating a heterogeneous, well circumscribed lesion in the left pre-epiglottic space abutting the posterior surface of the hyoid bone at the junction of the body and the cornua.
Mentions: A CT scan revealed a small, well-circumscribed, ovoid mass with central necrosis in the left pre-epiglottic space, abutting the posterior surface of the hyoid bone (Figure 1). Neither an ultrasound guided fine-needle aspiration biopsy, nor a core needle biopsy, despite multiple attempts, was successful in identifying the histology.

Bottom Line: Imaging demonstrated a 1.4 cm cystic lesion at the hyoid bone.A trans-cervical approach was used.Pathology revealed a necrotizing granuloma compatible with rheumatoid etiology.

View Article: PubMed Central - HTML - PubMed

Affiliation: Otorhinolaryngology - Head and Neck Surgery/Otolaryngology, The University of Houston Health Science Center, Houston, Texas, USA.

ABSTRACT
We report a case of a cervical rheumatoid nodule in close relation to the hyoid bone mimicking a metastatic carcinoma. A 74-year-old female with a 15-year history of rheumatoid arthritis (RA) on treatment with methotrexate presented with tenderness of the right base of tongue. Imaging demonstrated a 1.4 cm cystic lesion at the hyoid bone. Biopsies were unsuccessful and the patient required surgical resection of the mass. A trans-cervical approach was used. Pathology revealed a necrotizing granuloma compatible with rheumatoid etiology. The clinician should be aware that, in a patient with a neck mass, in the presence of active RA, rheumatoid nodules should be part of the differential diagnosis.

Show MeSH
Related in: MedlinePlus