Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
March 2022
Next Case of the Month Coming April 5...
Rheumatoid Pannus
- Clinical History:
- We present a case of a 61-year-old woman with a long-standing history of rheumatoid arthritis who was found to have a hypopharyngeal mass concerning for squamous cell carcinoma (SCC), the most common hypopharyngeal tumor.
- Upon arrival to the MICU, the patient was intubated and taken to the operating room for a tracheostomy and laryngoscopy with biopsy. Redundant edematous tissue throughout the larynx and postcricoid area with questionable ulceration was seen, with no obvious signs of malignancy.
- On pathology, this mass was later seen to be consistent with a rheumatoid pannus, rather than SCC. The patient was started on a steroid taper on the day of discharge starting with 60 mg of IV methylprednisolone, followed by PO prednisone 20 mg BID.
- Case Discussion:
- A rheumatoid pannus is generally defined as a chronically inflamed synovial membrane in patients with rheumatoid arthritis. The pathophysiology of the rheumatoid pannus, as well as the timing and location of its origin, is poorly understood.
- Patients with rheumatoid arthritis have been noted in literature to present with synovial involvement of the temporomandibular and cricoarytenoid joints.
- The most common hypopharyngeal masses are SCC and often present at an advanced state with frequent metastases given the abundant vascularity of the region, and thus biopsy should always be performed to rule this out.
- In patients with long-standing rheumatoid arthritis, a rheumatoid pannus in the cervical region can present as a hypopharyngeal mass mimicking SCC.
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