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. 1. Introduction Wegener’s granulomatosis (WG) is a systemic, autoimmune disease histologically characterised by a necrotizing granulomatous inflammation with vasculitis. It belongs to the group of antineutrophil cytoplasmic antibodies- (ANCA-) associated vasculitis which are responsible for the inflammation of WG. The diagnosis of WG is typically based on the recognition of the clinical picture and the detection of ANCA in the serum, especially cANCA anti-PR3 [1, 2]. The sinonasal tract is the most frequently affected site within the head and neck, and this site may be the only affected organ by WG [3]. However, the diagnosis of WG may be a challenge either when the patient refers to an oncologically oriented department or when facing with image studies (i.e., CT scan and PET) suggesting a malignant disease. These eventualities may contribute to the underdiagnosis WG, thus leading to a delay in the correct therapeutic approach. As far as histology is concerned, the presence of necrotizing granulomas inflammation and vasculitis is the hallmark of WG. However, these pathognomonic features may be missed by the pathologists either in the early stage of the disease or when facing with small fragments of tissue. We herein present a case of sinonasal WG clinically and radiologically mistaken for an undifferentiated carcinoma of the nasopharynx. 2. Case Presentation A 21-year-old girl was admitted to our hospital because of a 3-month history of otitis. A clinical evaluation, which included a nasal fibroscopic exam, revealed the presence of a vegetative and ulcerated mass of the rhinopharynx
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