We present the case of a patient with a tender mass in the pre-epiglottic region at the level of the hyoid bone, which final pathology demonstrated to be a rheumatoid nodule. Although rheumatoid nodules in the larynx have been described, focal involvement of the hyoid bone to our knowledge has not been reported in the literature.
Laryngeal abnormalities in RA can be seen on CT imaging in 50-75% of patients[3, 4]. The prevalence ranges from 13 to 75% in various clinical studies, and between 45 and 88% in postmortem studies[5]. Although these findings indicate that laryngeal involvement of RA is common, clinical suspicion is necessary to recognize it.
In a patient presenting with a laryngeal mass, the otolaryngologist should be cognizant that the differential diagnosis should include a malignant process, more frequently squamous cell carcinoma. Other malignant considerations include adenoid cystic carcinoma, lymphoma and sarcomas. Among the benign lesions, laryngocele, amyloidosis, papilloma and inflammatory processes such as tuberculosis and rheumatoid nodules2 should also be considered.
Most studies on laryngeal involvement of RA describe nodules at the CJ; however, nodules involving the hyoid, to our knowledge, have not been described. In our case, the nodule was traced to the posterior aspect of the hyoid bone. It is possible that the rheumatoid nodule had arisen from the union of the body to the lesser cornus of the hyoid, which is usually attached to the body of the bone by fibrous tissue, and occasionally to the greater cornua by distinct diarthrodial joints. This joint usually persists throughout life, but occasionally becomes ankylosed.
The presence of a new neck mass should always involve a thorough clinical history, examination and further evaluation, including imaging and directed biopsies, to exclude the presence of a malignancy. However, in patients with known RA and active disease, the clinician should be aware that, although rare, rheumatoid nodules should be included as one of the primary differential diagnoses of neck masses.