CASE REPORT - Mesenteric rheumatoid nodules masquerading as an intra-abdominal malignancy

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Mesenteric rheumatoid nodules masquerading as an intra-abdominal

malignancy: a case report and review of the literature

Sumeer Thinda2 and S Tomlinson1,2

1 VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

2 Department of Surgery, Geffen School of Medicine UCLA, Los

Angeles, CA, USA

World Journal of Surgical Oncology 2009, 7:59doi:10.1186/1477-7819-7-59

Published: 15 July 2009

Abstract

Background

Rheumatoid nodules are the most common extra-articular findings in

patients with rheumatoid arthritis. They occur most commonly at

pressure points such as the extensor surfaces of the forearms,

fingers, and occiput, but have also been reported to occur in unusual

locations including the central nervous system, pericardium, pleura,

and sclera. We present the unusual case of rheumatoid nodules in the

small bowel mesentery masquerading as an intra-abdominal malignancy.

Case presentation

A 65-year-old-male with a known history of longstanding erosive,

nodular, seropositive rheumatoid arthritis was incidentally found to

have a mesenteric mass on computed tomography (CT) exam of the

abdomen. This mass had not been present on prior imaging studies and

was worrisome for a malignancy. Attempts at noninvasive biopsy were

nondiagnostic but consistent with a " spindle " cell neoplasm.

Laparotomy revealed extensive thickening and fibrosis of the small

bowel mesentery along with large, firm nodules throughout the

mesentery. A limited bowel resection including a large, partially

obstructing, nodule was performed. Pathology was consistent with an

unusual presentation of rheumatoid nodules in the mesentery of the

small bowel.

Conclusion

Rheumatoid nodules should be considered in the differential diagnosis

of a patient who presents with an intra-abdominal mass and a history

of rheumatoid arthritis. Currently, no tests or imaging modality can

discriminate with sufficient accuracy to rule out a malignancy in this

difficult diagnostic delimma. Hopefully, this case will serve as

impetus for further study and biomarker discovery to allow for

improved diagnostic power.

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Read the full article here:

http://www.wjso.com/content/7/1/59

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