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Images in Clinical Rheumatology
Painful Subcutaneous Nodule
Nódulo subcutáneo doloroso
Jorge Santos-Juanesa,
Corresponding author
jorgesantosjuanes@gmail.com

Corresponding author.
, Cristina Galachea, Veronica Blancob
a Servicio de Anatomía Patológica, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
b Servicio de Radiodiagnóstico, Hospital Lozano Blesa, Zaragoza, Spain
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        "titulo" => "N&#243;dulo subcut&#225;neo doloroso"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Plain radiography shows a small calcification in a lateral region of the distal phalanx of the fifth toe&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 57-year-old woman who practiced hiking&#44; and had no history of disease&#46; She presented with a subcutaneous lesion measuring 5<span class="elsevierStyleHsp" style=""></span>mm in the fifth toe of her left foot that she had detected 12 weeks earlier&#46; The lesion was intensely painful and had undergone no changes&#46; Plain radiography of the foot revealed the presence of a small calcification on the lateral border of the distal phalanx of the fifth toe on left foot &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Analyses included inflammatory markers&#44; calcium&#44; phosphorus and uric acid&#44; which were all normal&#46; The pain disappeared after extirpation &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In 20 months of follow-up&#44; it has not reappeared&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis was tenosynovitis with psammomatous calcification&#46; Although it can be considered part of the spectrum of tumor lesions with calcification&#44; its clinical and histological features indicate that it is a distinct entity&#46; It is very seldom observed&#44; and rarely reported in the medical literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#8211;4</span></a> It can be described clinically as a single subcutaneous nodule or mass that is most frequently located in the acral regions of the extremities&#44; predominantly in adult women&#46; The patients mentioned a history of repeated injuries associated with their occupation or related to sports&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The lesions were situated in tendon or in peritendinous soft tissue&#46; From the histological point of view&#44; they were found to be a proliferation composed of histiocytes and &#40;myo&#41; fibroblasts&#44; and the presence of numerous psammoma bodies&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The differential diagnosis should include a variety of neoplastic and nonneoplastic processes of the distal extremities accompanied by calcifications&#58; gout&#44; pseudogout&#44; calcifying aponeurotic fibroma&#44; giant cell tumor of the tendon sheath&#44; synovial sarcoma and parosteal osteochondromatous proliferation&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#8211;4</span></a> The addition of tenosynovitis with psammomatous calcification to the differential diagnosis of painful acral lesions is important&#44; and will make it possible to avoid confusing them with other neoplastic or nonneoplastic diseases in which calcifications are present&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have received no funding for performing this project&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Santos-Juanes J&#44; Galache C&#44; Blanco V&#46; N&#243;dulo subcut&#225;neo doloroso&#46; Reumatol Clin&#46; 2017&#59;13&#58;301&#8211;302&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abundant psammoma bodies and proliferation of fusiform mononuclear cells &#40;H&#38;E 100&#215;&#41;&#46; &#40;A&#41; Presence of spherical calcifications &#40;arrows&#41; and multinuclear giant cells &#40;arrowhead&#41; &#40;H&#38;E 200&#215;&#41;&#46; &#40;B&#41; CD68 immunostaining reveals the presence of disseminated mononuclear cells surrounding the calcifications and multinuclear giant cells &#40;arrowhead&#41; &#40;CD68 200&#215;&#41;&#46;</p>"
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