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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Extensive extra-articular SOC&#46; A&#41; CT with no contrast agent in coronal plane which shows extensive irregular calcification of the interosseous membrane &#40;black arrow&#41; and mass of soft tissues in the lateral side of the ankle with scarce mineralisation &#40;White arrow&#41;&#46; B&#41; CT with no contrast agent in axial plane which shows masses of soft tissues in the dorsal and lateral side of the ankle&#44; with incipient diffuse mineralisation &#40;arrows&#41;&#46; C&#41; MR with axial sequence T1 with no contrast agent&#44; which shows the same masses as in B &#40;arrows&#41;&#44; isointense with respect to the muscle&#46; D&#41; MR with axial DP Fat Sat pulse sequence&#44; which shows a mass of adjacent soft tissues to the base of the fifth metatarsal&#44; of intermediate signal intensity due to incipient diffuse mineralisation &#40;arrow&#41;&#46; E&#41; MR with coronal 2 GRE sequence which shows the mass of soft tissues on the lateral side of the ankle extending towards the sinus tarsi &#40;arrow&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Synovial Osteochondromatosis &#40;SOC&#41; is a rare&#44; benign disease of the synovial membrane which may affect joints&#44; bursas and tendon sheaths&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Intra-articular involvement of large joints like the knee is most common&#46; Extra-articular SOC is rare and predominates in tendon sheaths or bursas&#44; mostly of the hands and ankles&#44; rarely involving the foot&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Few cases of extra-articular SOC have been described in the literature&#44; as far as we know and no cases with such an extensive extra-articular involvement have been described&#46; We present the exceptional case of a patient with extra-articular synovial osteochondromatosis with the involvement of the leg&#44; ankle and foot&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical observation</span><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 51-year-old man with no medical history of interest&#46; He was referred to our hospital due to a lump of 3<span class="elsevierStyleHsp" style=""></span>year onset and the slow growth in the external malleous and lateral side of the right foot&#44; which was hard and not moveable&#46; He stated it had been painful for a year and he suffered functional limitations&#46; He only referred to a twisting and trauma of the ankle and foot 10 years previously&#46; Laboratory tests were normal&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Plain radiography&#44; computerised tomography &#40;CT&#41; and magnetic resonance &#40;MR&#41; were performed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46;1</a>&#41;&#44; which showed extensive irregular calcification of the interosseous membrane of the leg and several lobulated masses of soft tissues with different levels of mineralisation in ankle and foot&#46; SOC&#44; multiple osteochondromas&#44; chondrosarcoma and disease from microcrystal deposits were included in the differential diagnosis&#46; A biopsy of the soft tissue mass of the lateral face of the ankle was performed and the anatomopathological report was&#58; extra-articular post-traumatic SOC&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">SOC is a rare&#44; benign entity which is characterised by metaplasia and the formation of multiple cartilaginous nodules in the synovial membrane of joints&#44; bursas and tendon sheaths&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It is more frequent in its intra-articular form&#44; with the extra-articular form being a rarity&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Proliferous cartilaginous nodules may become detached from the synovial joint&#44; forming loose intra-articular bodies&#46; On rare occasions these cartilaginous nodules may cross the articular capsule and proliferate as extra-articular&#44;<span class="elsevierStyleSup">1</span> which we believe happened in our case&#44; since the patient&#8217;s involvement was extensively intra and extra-articular&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">SOC may be classified into 2 forms&#58; primary and secondary&#46; The primary form is due to benign reactive metaplasia of the synovial membrane&#46; The secondary form is associated with pre-existing articular disease such as trauma&#44; osteonecrosis&#44; infection&#44; rheumatoid arthritis&#44; synovitis&#44; osteoarthritis&#44; osteochondritis dissecans and neuropathic arthropathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> The 2 forms have typical histopathological characteristics which differentiate them&#46; In our case&#44; the background of trauma supported the diagnosis of secondary SOC&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Extra-articular SOC is difficult to detect during initial stages&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Clinically speaking it may start with pain&#44; deformity&#44; functional limitation&#44; palpable mass and paresthesias due to neurovascular compression&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Radiological appearance depends on the stage of the disease and the degree of mineralisation of the cartilaginous nodules&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;6</span></a> If the extra-articular fragments are calcified they may be detected by plain radiography and CT&#44; but for the diagnosis of non calcified masses&#44; a study with MR is necessary&#44; with this technique being highly useful in the early stage of the disease&#44; for diagnosis and for assessing extension&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Definitive diagnosis is established using anatomopathological study&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There is a 5&#37; probability of malignancy&#44; essentially towards low-grade chondrosarcoma&#46; A form of aggressive presentation&#44; the rapid growth with destruction of neighbouring structures and multiple relapses after surgical treatment must lead to suspicion of a possible malignant transformation&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The treatment of choice for the intra-articular form is the arthroscopic extraction of loose bodies and synovectomy&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> but in the cases of extensive and extra-articular SOC&#44; as in our case&#44; open resection is indicated&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0060" class="elsevierStylePara elsevierViewall">The case presented illustrates an atypical form of secondary extra-articular SOC presentation with multiple involvements of leg&#44; ankle and foot&#46; Although this is rare&#44; it should be included within the differential diagnosis of peri-articular soft tissues of long duration with different degrees of mineralisation&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Extraarticular synovial osteochondromatosis is a very rare benign disease whose aetiology may be primary or secondary to pre-existing pathology or after trauma&#46; The diagnosis can be made with plain radiography and CT&#44; and MRI is necessary to evaluate the non-mineralized soft tissue component and assess extension&#46; It must be confirmed with a pathological study by biopsy or resection&#46; There is up to a 5&#37; chance of malignant transformation&#46; The treatment of choice for the extensive extra-articular form is surgery by open resection&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The case presented illustrates an atypical form of secondary extraarticular OCS with multiple involvement of the leg&#44; ankle and foot&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La osteocondromatosis sinovial &#40;OCS&#41; extraarticular es una enfermedad benigna muy infrecuente cuya etiolog&#237;a puede ser primaria o secundaria a una patolog&#237;a preexistente o tras traumatismos&#46; El diagn&#243;stico puede realizarse con radiograf&#237;a simple y TC&#44; siendo necesaria la RM para evaluar el componente de partes blandas no mineralizado y valorar la extensi&#243;n&#46; Debe confirmarse con estudio anatomopatol&#243;gico mediante biopsia o resecci&#243;n&#46; Tiene hasta un 5&#37; de posibilidades de experimentar transformaci&#243;n maligna&#46; El tratamiento de elecci&#243;n de la forma extraarticular extensa es quir&#250;rgico mediante resecci&#243;n abierta&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El caso presentado ilustra una forma de aparici&#243;n at&#237;pica de la OCS extraarticular secundaria con afectaci&#243;n m&#250;ltiple de la pierna&#44; tobillo y pie&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a Espinosa J&#44; Moya S&#225;nchez E&#44; Mart&#237;nez Mart&#237;nez A&#46; Osteocondromatosis sinovial extraarticular secundaria con afectaci&#243;n de pierna&#44; tobillo y pie&#46; Un caso excepcional&#46; Reumatol Clin&#46; 2021&#59;17&#58;482&#8211;484&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Extensive extra-articular SOC&#46; A&#41; CT with no contrast agent in coronal plane which shows extensive irregular calcification of the interosseous membrane &#40;black arrow&#41; and mass of soft tissues in the lateral side of the ankle with scarce mineralisation &#40;White arrow&#41;&#46; B&#41; CT with no contrast agent in axial plane which shows masses of soft tissues in the dorsal and lateral side of the ankle&#44; with incipient diffuse mineralisation &#40;arrows&#41;&#46; C&#41; MR with axial sequence T1 with no contrast agent&#44; which shows the same masses as in B &#40;arrows&#41;&#44; isointense with respect to the muscle&#46; D&#41; MR with axial DP Fat Sat pulse sequence&#44; which shows a mass of adjacent soft tissues to the base of the fifth metatarsal&#44; of intermediate signal intensity due to incipient diffuse mineralisation &#40;arrow&#41;&#46; E&#41; MR with coronal 2 GRE sequence which shows the mass of soft tissues on the lateral side of the ankle extending towards the sinus tarsi &#40;arrow&#41;&#46;</p>"
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