[Tuberculous arthritis of the temporomandibular joint caused by Mycobacterium bovis. A diagnostic conundrum]. / Artritis temporomandibular por Mycobacterium bovis. Un problema diagnóstico.

Infrequent variants of extrapulmonary tuberculosis pose a challenging public health problem because of the delay in their diagnosis and treatment. Joint involvement is usually encountered in major joints (hip, elbow, knee and ankle). Tuberculous involvement of the temporomandibular joint is extremely uncommon but must be considered in patients with pain, inflammation or joint stiffness not resolved with conventional treatment.

Artritis temporomandibular por Mycobacterium bovis. Un problema diagnóstico / Tuberculous arthritis of the temporomandibular joint caused by Mycobacterium bovis. A diagnostic conundrum

Las variantes infrecuentes de tuberculosis extrapulmonar son un reto de salud pública por abocar a un retraso diagnóstico-terapéutico. Las formas articulares se localizan en las grandes articulaciones (cadera, rodilla, codo, tobillo). La afectación temporomandibular es extremadamente infrecuente, pero debe ser considerada ante todo dolor, inflamación o rigidez articular que no se resuelva con tratamientos convencionales y, por tanto, ser investigada (AU)

Infrequent variants of extrapulmonary tuberculosis pose a challenging public health problem because of the delay in their diagnosis and treatment. Joint involvement is usually encountered in major joints (hip, elbow, knee and ankle). Tuberculous involvement of the temporomandibular joint is extremely uncommon but must be considered in patients with pain, inflammation or joint stiffness not resolved with conventional treatment (AU)

[Castleman's disease of the neck]. / Enfermedad de Castleman cervical.

Castleman's disease is an uncommon benign lymphoid disorder usually found in the mediastinum (70 %) which is thought to be due to antigenic hyperstimulation of unknown origin. Two histological subtypes may be found in relation to two different clinical patterns with clinical and therapeutic implications. Diagnosis is frequently accomplished only by histological analysis after surgery since no specific features have been found in imaging studies. Surgical excision is both diagnostic and curative in localized forms, whereas additional therapies are required in multicentric forms. This report is of Castleman's disease presenting as a neck mass, an infrequent occurrence, with an analysis of management controversies and a review of the literature.

Enfermedad de Castleman cervical / Castleman’s disease of the neck

La enfermedad de Castleman es un trastorno linfoproliferativo benigno muy poco frecuente que generalmente aparece en el mediastino (70 %) que se cree debido a una sobrestimulación antigénica de causa desconocida. Se han descrito dos diferentes subtipos histológicos con diferentes comportamientos clínicos e implicaciones terapéuticas. A menudo sólo se diagnostica esta enfermedad mediante el estudio histológico de la pieza tras su exéresis quirúrgica debido a la inexistencia de patrones de imagen específicos en las pruebas de radiodiagnóstico para esta enfermedad. El tratamiento quirúrgico es diagnóstico y a la vez curativo en las formas localizadas, mientras que son necesarios tratamientos complementarios en las formas multicéntricas. Describimos un caso de enfermedad de Castleman de presentación cervical, forma infrecuente de esta enfermedad, y realizamos una revisión de la literatura disponible incidiendo en las controversias que surgen en cuanto a su diagnóstico y tratamiento

Castleman’s disease is an uncommon benign lymphoid disorder usually found in the mediastinum (70 %) which is thought to be due to antigenic hyperstimulation of unknown origin. Two histological subtypes may be found in relation to two different clinical patterns with clinical and therapeutic implications. Diagnosis is frequently accomplished only by histological analysis after surgery since no specific features have been found in imaging studies. Surgical excision is both diagnostic and curative in localized forms, whereas additional therapies are required in multicentric forms. This report is of Castleman’s disease presenting as a neck mass, an infrequent occurrence, with an analysis of management controversies and a review of the literature

[Synchronous ENT lymphoepitheliomas. Controversies on their diagnosis and treatment]. / Linfoepiteliomas sincrónicos en áreas otorrinolaríngeas. Controversias diagnósticas y terapéuticas.

Lymphoepithelial carcinomas are characterized by proliferation of undifferentiated malignant epithelial cells together with an infiltrate of mature lymphocytes. They mainly appear in the nasopharynx but can also be encountered in other upper and lower aerodigestive sites such as oropharynx, stomach, trachea, and others. When they occur in the larynx they usually do so in the laryngeal ventricle and are characterized by protrusion of the laryngeal band, visible in laryngoscopy. They mainly metastasize to cervical lymph nodes no matter what size the tumour is and distant non-nodal metastases are not infrequent. Cases of 2 synchronous lymphoepithelial tumours in ENT regions without nodal involvement, albeit theoretically possible, are very uncommonly encountered. The very scant reports of primary laryngeal lymphoepitheliomas or only-laryngeal metastatic tumours make 2 simultaneous ENT lymphoepitheliomas an exceedingly rare form of presentation that may lead to important controversies regarding their diagnosis, staging and treatment. A case of 2 synchronous neoplasms in the larynx and cavum is reported and the most significant aspects of this uncommon feature are discussed.

Linfoepiteliomas sincrónicos en áreas otorrinolaríngeas. Controversias diagnósticas y terapéuticas / Synchronous ENT lymphoepitheliomas. Controversies on their diagnosis and treatment

Los linfoepiteliomas se definen por proliferación de células malignas epiteliales indiferenciadas junto con un infiltrado de linfocitos maduros. Aparecen principalmente en la nasofaringe, pero también pueden hacerlo en otras regiones de las vías aerodigestivas superiores e inferiores, como la orofaringe, el estómago, la tráquea u otros. Cuando aparecen en la laringe, lo hacen habitualmente a nivel del ventrículo laríngeo y se caracterizan por una protrusión de la banda laríngea visible en la laringoscopia. Metastatizan principalmente a ganglios linfáticos cervicales independientemente del tamaño del tumor y es frecuente encontrar metástasis no linfáticas a distancia presentes en el momento del diagnóstico. Son muy raros los casos de dos linfoepiteliomas sincrónicos otorrinolaríngeos sin afección de las cadenas ganglionares cervicales, aunque teóricamente son posibles. Las escasas descripciones existentes de linfoepiteliomas primarios de laringe o metástasis únicas laríngeas de linfoepiteliomas de cavum u otros tumores hacen que dos linfoepiteliomas sincrónicos en áreas otorrinolaríngeas constituyan una forma de presentación extremadamente rara que puede llevar a importantes controversias en su diagnóstico, estadificación y tratamiento. Los autores presentan un caso de dos lesiones sincrónicas, a nivel de cavum y laringe respectivamente, y una discusión acerca de los aspectos más significativos de esta infrecuente forma de presentación

Lymphoepithelial carcinomas are characterized by proliferation of undifferentiated malignant epithelial cells together with an infiltrate of mature lymphocytes. They mainly appear in the nasopharynx but can also be encountered in other upper and lower aerodigestive sites such as oropharynx, stomach, trachea, and others. When they occur in the larynx they usually do so in the laryngeal ventricle and are characterized by protrusion of the laryngeal band, visible in laryngoscopy. They mainly metastasize to cervical lymph nodes no matter what size the tumour is and distant non-nodal metastases are not infrequent. Cases of 2 synchronous lymphoepithelial tumours in ENT regions without nodal involvement, albeit theoretically possible, are very uncommonly encountered. The very scant reports of primary laryngeal lymphoepitheliomas or only-laryngeal metastatic tumours make 2 simultaneous ENT lymphoepitheliomas an exceedingly rare form of presentation that may lead to important controversies regarding their diagnosis, staging and treatment. A case of 2 synchronous neoplasms in the larynx and cavum is reported and the most significant aspects of this uncommon feature are discussed