Rheumatic diseases can be a paraneoplastic syndrome for an occult neoplasia. Some syndromes are more characteristic than others. In this case report, we present a patient with musculoskeletal symptoms suggestive of both carcinomatous arthritis and polymyalgia rheumatica that was shown to have adenocarcinoma of the lung. The musculoskeletal symptoms accompanied the course of the disease, disappearing with the treatment and re-occurring when it relapsed.

The diagnosis of a neck mass can present a challenge. In the adult the most common diagnosis is malignancy, and both primary and metastatic tumors should be considered. Other frequent options are infectious processes. We present the case of an 88-year-old female patient with a submandibular mass with inflammatory signs, unresponsive to antibiotic therapy, with fine needle aspiration biopsy showing an inflammatory lesion. The mass developed over a month with associated anorexia resulting in admission for diagnosis with open biopsy. Following admission, an invasive carcinoma of the right breast was diagnosed, and the Mycobacterial culture of the submandibular mass biopsy was positive for Mycobacterium tuberculosis. Immunosenescence the elderly contributes to vulnerability to cancers but also infections which can present atypically and thus result in delayed diagnosis.Other less frequent causes are gout [9], inflammatory pseudotumor [10], Kimura's disease [11], Castleman's disease [12] and sarcoidosis [13].Diagnosis is usually made by fine needle aspiration cytology, which is a rapid and sensitive method [1,6]. If the diagnosis remains unclear, an open biopsy may be necessary [1,6]. Laboratory tests vary with presentation, but should include inflammatory parameters including