Fine-needle aspiration of rheumatoid nodule: A case report with review of diagnostic features and difficulties

Patients with rheumatoid arthritis may develop extra-articular subcutaneous nodules as part of the systemic disease or as initial manifestation. These lesions may represent significant diagnostic dilemmas in patients with clinical suspicion of malignancy. In this setting, fine-needle aspiration (FNA) of the nodules may be the simplest and most appropriate diagnostic approach. In the literature, however, there are only sporadic reports describing FNA cytology of a rheumatoid nodule. In this report, we present a case of a 67-year-old male with a history of rheumatoid arthritis and squamous-cell carcinoma of the larynx who developed a subcutaneous neck nodule in the immediate proximity of the surgical scar. Clinically, because of the history of squamous-cell carcinoma and location of the lesion, the nodule was suspected to be metastatic cancer, but was proven by FNA biopsy to represent rheumatoid disease. Cytological criteria of rheumatoid nodule and diagnostic difficulties are discussed. (C) 2003 Wiley-Liss, Inc.