When is a biopsy justified in a case of relapsing polychondritis?

Relapsing polychondritis (RP) is a relatively rare rheumatic condition of unknown aetiology. It is characterized by recurrent episodic inflammation of cartilaginous structures (nose, ear and trachea). The clinical diagnosis of polychondritis can frequently be made with confidence in the absence of histological confirmation. A 61-year-old diabetic man, with bilateral relapsing aural inflammation, left ear deafness with tinnitus and pain at the sternocostal junctions is reported. After clinical diagnosis of relapsing polychondritis steroid therapy was started. An ear cartilage biopsy was performed confirming the clinical diagnosis. Subsequently soft tissue infection occurred at the operation site. The abscess was drained and oral ciprofloxacin was given with complete resolution of the infection over 30 days. As the infection is the main cause of death in these patients, we analyse whether biopsy is absolutely necessary for the diagnosis of RP in some patients.

Autoimmune deafness is not related to hyperreactivity to type II collagen.

The pathogenic role of anti-type II collagen was analysed in a variety of hearing losses, in age-matched controls and in different autoimmune diseases. The immune reactivity of peripheral blood lymphocytes to type II collagen was studied by the degree of proliferation measured as the incorporation of bromodeoxyuridine in cultured lymphocytes. The anti-type II collagen antibodies showed a very low incidence in the hearing loss group. Lymphocytes of otosclerosis, Meniere's disease and other sensorineural deafness patients proliferated in response to concanavalin A and to type II collagen to a lower extent than peripheral blood lymphocytes from healthy controls. Nonetheless, these differences were not statistically significant. The immune hyperreactivity to type II collagen cannot explain the autoimmune mechanism of hearing losses. Humoral and cellular hyperreactivities to inner ear proteins different from type II collagen, could explain the autoimmune mechanism of deafness.

[Pseudosarcoma of the larynx]. / Consideraciones sobre el pseudosarcoma de laringe.

Pseudosarcoma of the larynx is a tumor derived as much from connective tissue as from epithelial tissue. There has been much discussion about the malignant nature of the sarcomatous stroma, sometimes considered a benign reaction. However they describe in the literature metastasis cases in which only the sarcomatous element has been demonstrated. We present a case of vocal cord pseudosarcoma in which ten months after performing cordectomy, we can't rule out recurrent disease in spite of the histopathological examination of the cord being negative.

[Histiocytosis X: problems of differential diagnosis in otorhinolaryngology]. / Histiocitosis X: problemas de diagnóstico diferencial en ORL.

Four cases of Histiocytosis X are presented here, with symptoms otorhinolaryngologic. The evolution has been good, so they have been without disease for three of four years. We are presenting the problem of differential diagnosis of this disease for ENT specialists and the delay in the diagnosis. All our cases were diagnosed after one year of the beginning of symptoms.

[Glomus jugulare tumor. Apropos of 2 cases]. / Glomus yugular. A propósito de dos casos.

We present two clinical cases of jugular glomus in which different kinds of treatment have been adopted. In literature we can find a review of the utility and morbidity of the different methods of exploration as well as the results obtained by the different authors according to the kind of treatment. Nevertheless we don't come to definite conclusions due to the fact that the classifications and curing criteria very in the different series.

[Relapsing polychondritis. Apropos of a case]. / Policondritis recidivante. A propósito de un caso.

Relapsing polychondritis is not a very frequent systemic disease. Nevertheless, it has to be borne in mind since very often the first symptoms appear in the sphere of otorhinolaryngology. We are faced with the problem of differential diagnosis in a case which in the beginning seemed to be a neurological pattern. The definitive diagnosis was not established until 15 months after the appearance of the symptoms when, after several outbreaks, the clinical pattern was clearer. As we have to deal with a recurrent and systemic pathology whose diagnosis is eminently clinical, long-term pursuit and valuation are necessary to allow us to know the natural history of the disease as well as the reaction to the treatment.