UNCOMMON PRESENTATIONS OF OROPHARYNGEAL NECK MASS: DIAGNOSING ANKYLOSING SPONDYLITIS AND DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS

Background / Objective
Ankylosing spondylitis (AS) is a type of arthritis that causes inflammation in the joints and ligaments of the spine, but can
also affect peripheral joints. Inflammation of the joints and tissues of the spine can cause stiffness, and in severe cases, it
can cause the spinal cord to fuse and can lead to an inflexible spine. Although researchers do not know the cause of
ankylosing spondylitis, studies show that genes and the environment can lead to the development of the disease.
Researchers know that the HLA-B27 gene increases the risk of ankylosing spondylitis, but environmental factors also play a
role. Certain factors can increase the risk of developing the disease, such as family history and genetics, age (most people
develop symptoms before 45 years of age) and people with Crohn's disease, ulcerative colitis, or psoriasis can be more
likely to develop the disease. Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterised by
excessive new bone formation in the axial and peripheral skeleton. The pathogenesis of DISH is not well understood and is
currently considered a noninflammatory disease and is observed mainly in adults over 45 years of age, with a predominance
of men and associated with metabolic syndrome, obesity, hypertension, and diabetes mellitus, affects all populations;
however, its prevalence is thought to be the highest in developed countries. DISH can be asymptomatic or manifest as back
and cervical pain, dysphagia, pain at peripheral entheseal sites, and restriction of spinal column movement, often imitating
AS.
Methods
In this case series, we present two patients who were referred for imaging investigations with suspicion of an oropharyngeal
region lesion.
Results
The first patient presented to the physician with complaints of cough, and on examination by the otolaryngologist, a possible
lesion was observed in the oropharynx region. Subsequently, magnetic resonance imaging of the soft tissues of the neck
revealed prominent anterior spondylophytes of the cervical vertebrae at the level of C2-C3, causing compression of the
oropharynx, suggesting ankylosing spondylitis in the patient. The second patient was referred by an otolaryngologist for a
head and neck soft tissue examination with intravenous contrast, suspecting a cyst in the oropharynx region. A computed
tomography scan showed massive anterior spondylophytes of the cervical vertebrae more involvement at the C2-C3 level,
resulting in compression of the oropharynx, calcified anterior longitudinal ligament, and radiological appearance of DISH
syndrome in the patient.
Conclusions
In these cases, we found that the complexity of the conditions highlights the importance of radiology as an indispensable tool
to ensure accurate diagnoses, because the cause of the possible neck mass can be unexpected and the spine should be
evaluated very carefully during examinations of the soft tissues of the neck, as sometimes what we see may not always be
what appears, which makes these cases particularly intriguing.