Rheumatoid Nodule

A case of tracheal rheumatoid nodules in a 45-year-old Chinese man has been reported.17 The patient had suffered rheumatoid arthritis for 7 years, with articular manifestations and deformities. Subcutaneous rheumatoid nodules had been present over his elbows and hands.

Endoscopy showed four smooth, whitish nodules, each 3 to 5 mm in diameter. Further specification was not possible on endoscopic findings. Histologic examination showed foci of necrobiosis and vascular fibrinoid necrosis in the vessels surrounded by palisading histiocytes.

Among the histologic differential diagnoses are necrotizing granulomatous diseases such as tuberculosis and histoplasmosis. Amyloid deposits must also be separated from central necrobiosis of this lesion, which may have a similar eosinophilic patternless aspect. Amyloid material, however, is more homogeneous, and stains with Congo red and other special histochemical stains.

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