Severe neck stiffness in a 20‐year‐old gelding with cytological findings suggestive of cervical vertebral neoplasm

Summary A 20‐year‐old warmblood gelding was referred for the evaluation of severe cervical stiffness and pain. Radiographic examination revealed marked arthropathy of the C3–C4 articular processes, with severe remodelling and narrowing of the C3–C4 intervertebral space. Ultrasonographic examination confirmed the marked irregularities of the articular surfaces and the advanced synovitis, as well as a well‐defined echogenic parenchyma‐like structure cranial to the C3–C4 articular facets. Ultrasound‐guided fine‐needle aspiration (FNA) of this area revealed two distinct cell populations: a predominant inflammatory infiltrate and cohesive epithelial cells with high nuclear‐to‐cytoplasmic ratios, anisocytosis and anisokaryosis, suggestive of a poorly differentiated carcinoma. Advanced imaging and biopsy were not feasible due to owner constraints, and surgical removal was precluded by the localisation and extent of the lesion. Palliative therapy with steroidal anti‐inflammatory drugs, mesotherapy and intra‐articular corticosteroids temporarily improved comfort, but progressive neurological deterioration ultimately led to euthanasia. This case highlights the diagnostic value of integrating radiography, ultrasonography and ultrasound‐guided FNA for the identification of rare neoplastic conditions in equine patients. It underscores the diagnostic relevance of minimally invasive techniques, not only for diagnosis but also for reaching a prognosis and guiding potential treatment options.