[Cystic tumors in the retrorectal space. Do these two cases have something in common?]. / Tumoraciones quísticas del espacio retrorrectal. ¿Tienen algo en común estos dos casos?

Cystic lesions in the retrorectal or presacral space present a broad differential diagnosis. Rare but typical lesions at this site are those related to embryonic development, which are the most frequent presacral congenital lesions in adults. Amongst these tumors, epidermoid cysts and cystic hamartomas are the most common lesions. Cystic masses, which are asymptomatic in approximately 50% of the cases at diagnosis, may show complications such as infection or malignant degeneration. Initial diagnosis is based on imaging techniques although definite lesion characterization, essential due to their malignancy risk, is given by the pathological analysis of the surgical piece.

An intra-thyroid thyroglossal duct cyst.

Thyroglossal duct cysts can be found in several different locations, although intra-thyroid presentations are rare. We present the case of an 11-year-old patient with a visible neck mass on the right thyroid lobe. On sonogram, it was consistent with a unilocular cyst measuring 2 centimeters in diameter. The cyst did not take up the radioisotope during a gammagram. Fine needle aspiration cytology suggested a diagnosis of thyroglossal duct cyst. At surgery, we found that there were no lesion-dependent thyroglossal tracts; we therefore performed a simple enucleation of the cyst, sparing the rest of the gland. The pathologic examination confirmed that it was an intra-thyroid thyroglossal duct cyst. After 8 months of follow-up, the patient has remained without complications of any kind or recurrence. Only four prior cases of intra-thyroid thyroglossal cysts have been described in the pediatric population. Half of them presented with a typical thyroglossal tract crossing the hyoid and the other half presented an isolated cyst. It is highly unlikely that a cold, cystic, thyroid mass in a child is a thyroglossal duct cyst. Diagnosis is made on the basis of fine needle aspiration cytology and the lesion is treated surgically. A thyroglossal tract must be methodically sought out during intervention, although they frequently do not exist.

[Acute myocardial infarction in a 5-year-old boy]. / Infarto agudo de miocardio en un niño de cinco años.

We present the case of a child five and half years-old that died suddenly due to an acute myocardial infarction. The anatomopathological study showed a total obstruction of the left coronary ostium by mixoide dysplasia of the aortic valve. We revise the literature and briefly expose the more frequent causes of infarction in infancy.

[Early detection of breast cancer in Navarra. Diagnostic approach in women sent to a referral hospital]. / Detección precoz del cáncer de mama en Navarra. Conducta diagnóstica en las mujeres enviadas a un hospital de referencia.

BACKGROUND: Breast cancer screening programs represent an important increase in the number of patients to be evaluated and a higher proportion of subclinical lesions detected in reference hospitals. The authors' experience related to an early detection program initiated in Navarra, Spain (PDPCM) is herein presented. METHODS: The diagnoses made in 319 women referred from the PDPCM to the authors' hospital for mammographic suspicion of malignancy were reviewed. Directed surgical biopsy was carried out in 89 women (27.9%) without previous cytologic study. Fine needle aspiration punction and cytology (FNAP-cytology) were performed as the first diagnostic test in 216 lesions (67.7%) 53 of which were palpable and 163 nonpalpable. Aggressive techniques were not indicated in 14 cases (4.4%). RESULTS: A total of 136 carcinomas (42.6%) were diagnosed and benign lesions were find at biopsy in 112 (35.1%) women. The fifty-seven lesions (17.9%) which did not show malignancy on FNAP-cytology were not biopsied given the insufficient degree of suspicion. Only one false negative has appeared in this group from 27 to 48 months after the first consultation. The global diagnostic reliability was of 99.68%. CONCLUSIONS: Directed surgical biopsy is the most reliable technique for the diagnosis of nonpalpable breast lesions in early stages and is always necessary when there is medium or high radiologic suspicion of malignancy. Fine needle aspiration puncture is a very useful technique to confirm malignancy and to avoid unnecessary biopsies in low suspicion lesions.

[Lymphocytic meningoradiculitis (Bannwarth's syndrome). Neurologic involvement of Lyme disease]. / Meningoradiculitis linfocitaria (síndrome de Bannwarth). Expresión neurológica de la enfermedad de Lyme.

We describe a patient with Lyme's disease who showed neurologic symptoms of meningoradiculitis (Bannwarth's syndrome) and had no previous history of exposure to tick bite or chronic erythema migrans. He had longterm fever and bilateral facial paralysis. Antibody titres for Borrelia Burgdorferi in serum and cerebrospinal fluid (CSF) were increased. The CSF changes showed an intrathecal production of immunoglobulins (presence of plasmatic cells and immunoblasts; IgG-CSF: IgG-serum ratio much higher than albumin-CSF: Albumin serum ratio, according to Reiber's diagram; presence of oligoclonal bands). Therapeutic response to high doses of penicillin was resolutive. The second day of treatment the patient developed uveitis, that was treated with corticoids.