Diagnostic Consideration for Sinonasal Wegener’s Granulomatosis Clinically Mistaken for Carcinoma

Abstract

We report a case of Wegener's granulomatosis clinically mistaken for carcinoma in a 21-year-old girl presenting with an ulcerated mass of the nasopharynx associated with enlarged laterocervical nodes. The lesion was clinically suspected as malignant on the basis of clinical and radiological findings (namely, computed tomography scan and positron emission tomography). However, multiple biopsies were not conclusive for malignancy showing histological change suggestive of Wegener's granulomatosis. A serum determination of cANCA supported the diagnosis of Wegener's granulomatosis. Clinical findings and image studies suggested an erroneous diagnosis of malignancy whereas a definitive diagnosis of Wegener's granulomatosis was achieved only after repeated biopsies thus leading to a correct therapeutic approach. The Wegener granulomatosis must be added to the list of the differential diagnoses of the masses of the nasopharynx associated with or without enlarged laterocervical nodes.

Granulomatosis with polyangiitis: Special focus on suggestive imaging findings in head and neck involvement

“…Nasopharyngeal involvement was detected particularly in the scans at onset; involvement during disease follow-up was seen only in one patient. The limited data in literature comes from CT or conventional MRI characteristics of nasopharynx and/ or eustachian tube involvement without specifying diffusion properties of inflammatory infiltration [8][9][10]. In our series, MRI characteristics were similar with the other ENT parts of involvement and reflected the granulomatous nature of the inflammation.…”

“…The imaging findings of nasopharyngeal and temporal involvement are less well recognized compared to sinonasal and laryngeal involvement. The limited radiologic data comes from single cases or small case series of GPA involvement in nasopharynx mimicking nasopharyngeal cancer [8][9][10]. The aim of our study was to reveal the relative frequencies of more specific imaging findings (i.e., osseous erosions or destructions, neoosteogenesis, subglottic stenosis) and to investigate the prevalence and imaging characteristics of previously under-recognized nasopharyngeal involvement in GPA.…”

Three atypical manifestations of granulomatosis with polyangiitis: lateral medullary syndrome, anterior cheek mass and melting scleritis of eye

“…There have also been reports of GPA with ENT masses in the sinus, ear and nose first referred as a carcinoma [ 12 , 13 ]. Our patient did not have positive ANCA, lung and kidney involvement so the main diagnosis was the ‘limited’ or ‘localized’ form of GPA.…”

Head and Neck Radiology in AAV

“…The imaging characteristics of nasopharyngeal and temporal involvement are under-recognized compared to sinonasal manifestations. The radiologic data comes generally from single cases and small series of nasopharyngeal involvement mimicking nasopharyngeal carcinoma [10][11][12]. In the study enrolled in Hacettepe University Center of Vasculitis [5], nasopharyngeal involvement is revealed as not an infrequent finding; detected in 23% of the patients, particularly at onset.…”