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Sternoclavicular Joint Involvement of Rheumatoid Arthritis Mimicking Malignancy: A Case Report.

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A rare sternoclavicular joint mass in a rheumatoid arthritis patient mimicked malignancy. Diagnosis required advanced imaging and biopsy, highlighting the need for interdisciplinary collaboration in complex cases.

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Area of Science:

  • Rheumatology
  • Oncology
  • Pathology

Background:

  • Rheumatoid arthritis (RA) can affect the sternoclavicular joint, presenting diagnostic challenges.
  • Progressive sternoclavicular joint masses with bone erosion and systemic symptoms necessitate exclusion of malignancy.
  • Autoimmune-related lymphoproliferations can occur in patients with rheumatic diseases.

Purpose of the Study:

  • To describe a case of a sternoclavicular joint mass in a patient with refractory rheumatoid arthritis.
  • To discuss the differential diagnoses, including malignancy and autoimmune lymphoproliferation.
  • To emphasize the importance of interdisciplinary collaboration for accurate diagnosis.

Main Methods:

  • Clinical presentation of a 73-year-old woman with rheumatoid arthritis and persistent fever.
  • Imaging studies including chest computed tomography (CT) and positron emission tomography/computed tomography (PET/CT).
  • Histopathologic examination of initial and repeat biopsies of the sternoclavicular joint mass.

Main Results:

  • A growing mass at the right sternoclavicular joint with osteolysis and clavicular erosions was identified.
  • Initial biopsy was nondiagnostic, suggesting lymphoid malignancy, while rebiopsy indicated a benign lesion.
  • PET/CT ruled out distant malignancy, and the final diagnosis leaned towards a benign, possibly autoimmune-related, lesion.

Conclusions:

  • Sternoclavicular joint lesions in RA patients can mimic malignancy, requiring thorough investigation.
  • Accurate diagnosis relies on a combination of advanced imaging and histopathology.
  • Interdisciplinary collaboration is crucial for managing complex cases with overlapping rheumatic and potential neoplastic features.