Giant extra-articular synovial osteochondromatosis of the sinus tarsi: a case report

Isolated synovial chondromatosis of the ankle: A case report

INTRODUCTION AND IMPORTANCE

At the age of 20, young adults are most susceptible to synovial chondromatosis, a rare condition characterized by the metaplasia of the synovial membrane into cartilaginous or osteocartilaginous tissue. Synovial chondromatosis is exceptionally uncommon in the ankle.

CASE PRESENTATION

An orthopedist evaluated a 26-year-old man with a history of recurring ankle trauma over a period of 6 months, swelling and pain. An ankle radiograph revealed calcified foreign bodies, while arthrography displayed enlarged oval bodies with contrasting features and intra-articular effusion encapsulated heterogeneously. Subsequent arthroscopy, following contrast injection, revealed intra-articular contrast effusion. During the arthroscopic procedure, multiple osteochondromas were discovered. A synovectomy was performed, and pathological analysis confirmed the presence of synovial chondromatosis.

CLINICAL DISCUSSION

Synovial chondromatosis of the ankle is an exceptionally rare condition with only a handful of documented cases in the literature. Isolated instances of ankle synovial chondromatosis have been reported, and these cases have been managed using both open and arthroscopic techniques. Arthroscopic intervention offers potential benefits such as improved joint access, reduced morbidity, and quicker rehabilitation and recovery. However, arthroscopic surgery might pose the risk of incomplete synovectomy or residual loose bodies.

CONCLUSION

Synovial chondromatosis of the ankle represents a chronic and rare ailment. Arthroscopic treatment stands out as an effective and dependable solution, offering various potential advantages over open surgery. This case report is presented due to the rarity and clinical significance of the condition.

Management of temporomandibular joint diseases: a rare case report of coexisting calcium pyrophosphate crystal deposition and synovial chondromatosis

BACKGROUND

The coexistence of calcium pyrophosphate dihydrate crystal deposition (CPP) and synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is rarely reported. CPP disease (CPPD) is complex arthritis synonymous with excessive pyrophosphate production and variable aberrations in mineral and organic phase metabolism of the joint cartilage, leading to local inundated CPP and crystal deposition of partially deciphered predispositions. Meanwhile, SC is a rare benign synovial joint proliferative disease of unclear etiology and has a low risk of malignant transformation. However, SC manifests severe joint disability and dysfunction because of connective tissue metaplasia of the synovial membrane, which forms cartilaginous nodules with or without calcifications or ossifications. These nodules often detach and form intra-articular loose bodies and very rarely within extraarticular spaces.

CASE PRESENTATION

We report the case of a 61-year-old man to expand the body of literature on these unusual coexisting arthropathies of the TMJ. The patient presented to our hospital in 2020 with complaints of pain in the right TMJ and trismus for over 6 months. Radiographic assessments of the TMJ provided a preoperative provisional diagnosis of SC. However, the histopathology of the open biopsy revealed tumor-like lesions comprising several deposits of rhomboid and rod-shaped crystals that displayed positive birefringence in polarized light, confirming a coexistence of CPPD. A second-stage operation was performed for the complete removal of the loose bodies and chalk-like lesions including synovectomy. No evidence of recurrence was recorded after a follow-up of nearly 1.5 years.

CONCLUSIONS

Isolated CPPD and SC of the TMJ are prevalent in the literature however, monoarticular coexistence of these diseases is rare, due to the lack of consistency in the diagnostic criteria in clinical practice. Moreover, optimal treatment depends on several considerations. This report delineated the molecular etiopathology and underscored the need for continued deciphering of the causal mechanisms of coexisting CPPD and SC of the TMJ. In addition, the importance of confirmatory testing for accurate diagnosis, and appropriate management of these diseases were discussed.

Secondary extra-articular synovial osteochondromatosis with involvement of the leg, ankle and foot. An exceptional case

Extraarticular synovial osteochondromatosis is a very rare benign disease whose aetiology may be primary or secondary to pre-existing pathology or after trauma. The diagnosis can be made with plain radiography and CT, and MRI is necessary to evaluate the non-mineralized soft tissue component and assess extension. It must be confirmed with a pathological study by biopsy or resection. There is up to a 5% chance of malignant transformation. The treatment of choice for the extensive extra-articular form is surgery by open resection. The case presented illustrates an atypical form of secondary extraarticular OCS with multiple involvement of the leg, ankle and foot.

Secondary Extra-Articular Synovial Osteochondromatosis with Involvement of the Leg, Ankle and Foot. An Exceptional Case

Extraarticular synovial osteochondromatosis is a very rare benign disease whose aetiology may be primary or secondary to pre-existing pathology or after trauma. The diagnosis can be made with plain radiography and CT, and MRI is necessary to evaluate the non-mineralized soft tissue component and assess extension. It must be confirmed with a pathological study by biopsy or resection. There is up to a 5% chance of malignant transformation. The treatment of choice for the extensive extra-articular form is surgery by open resection. The case presented illustrates an atypical form of secondary extraarticular OCS with multiple involvement of the leg, ankle and foot.

Extraarticular extrasynovial solitary osteochondromatosis of the ankle: A rare case report and review of literature

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Extra articular osteochondromatosis is rare and scarcely reported around the ankle joint.

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Due to the subtle clinical and radiological presentation of SC they often lead to a diagnostic challenge.

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Higher degree of suspicion enables early diagnosis, thereby preventing both morbidity and inadequate treatment.

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Although MRI plays a key role in deciding the extent of the surgery, confirmation can be made only with histopathology.

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Long term follow up is mandatory considering both the risk of local recurrence and rare malignant transformation.

Introduction

Synovial chondromatosis (SC) is a relatively common benign condition of the synovial joint characterized by the formation of cartilaginous nodules in synovium. However, extra articular osteochondromatosis is rare and only few have been reported around the ankle joint. We have reported such a presentation and have reviewed the literature extensively.

Presentation of case

We present a 26 year old male patient with a painless swelling over the lateral aspect of his left ankle. He was subjected to clinical and radiological examination which revealed a firm to hard swelling around the lateral malleolus and a lobulated juxtacortical cystic lesion with calcification. He underwent a surgical excision and subsequent histopathology was suggestive of SC.

Discussion

The subtle clinical and radiological presentation of SC can lead to both a delay in the diagnosis and a diagnostic dilemma if suspicion is low. Early meticulous diagnosis and management can curtail morbidity.

Conclusion

The degree of suspicion needs to be high to diagnose the condition early to prevent both morbidity and inadequate treatment. Histopathological corroboration is needed to rule out uncommon but possible malignant transformation, notably in long standing cases.

Synovial chondromatosis of the foot: Two case reports and literature review

BACKGROUND

Primary synovial chondromatosis (PSC) is a rare arthropathy of the synovial joints characterized by the formation of cartilaginous nodules, which may detach and become loose bodies within the joint and may undergo secondary proliferation. PSC of the foot and ankle is exceedingly rare, with only a few cases reported in the literature. The diagnosis may be difficult and delayed until operative treatment, when it is confirmed by histological assessment. PSC may degenerate into chondrosarcoma. Operative treatment is the gold standard aiming to minimize pain, improve function, prevent or limit progression of arthritis. Surgical treatment consists in debridement by arthrotomic or arthroscopic management, but there is no consensus in the literature about timing of surgery and surgical technique. Thus, the aim of this study is to report the outcomes of the surgical treatment of two cases, together with a literature review.

CASE SUMMARY

We report two cases of patients affected by PSC of the foot in stage III, according to the Milgram classification: the former PSC localized in the ankle that underwent open surgery consisted of loose bodies removal; the latter in the subtalar joint, and the choice of treatment was the arthrotomy and debridement from loose bodies, in addition to the subtalar arthrodesis. Both patients returned to complete daily and working life after surgery.

CONCLUSION

Synovial chondromatosis is a rare benign pathology, even rarer in the ankle joint and especially in the foot. Surgery should be minimal in patients with ankle PSC, choosing the correct timing, waiting if possible until stage III. More aggressive and early surgery should be performed in patients with PSC of the foot, particularly the subtalar joint, due to the high risk of arthritic evolution.

Symptomatic os talus secundarius: a case report and review of the literature

Os talus secundarius is an extremely rare accessory ossicle located at the lateral aspect of the talus just anterior to the fibula. Although rarely seen, it may cause lateral-sided chronic ankle pain. Only a few cases of symptomatic os talus secundarius have been reported to date. Herein, a 42-year-old male patient with symptomatic os talus secundarius is presented, and its imaging findings, differential diagnosis, and treatment are discussed.

LEVEL OF EVIDENCE

Level IV.

Giant extra-articular synovial osteochondromatosis of the left proximal thigh: A case report

Extra-articular synovial osteochondromatosis is a rare disease. The present study describes the case of a 46-year-old female who suffered from extra-articular synovial osteochondromatosis of the left proximal thigh with limited hip movement. The patient underwent a total tumor resection and recovered well. The tumor was 15×14×5 cm³ in size and located in the muscle gap. After a 3-month follow-up, the patient's left hip motion was improved and a computed tomography scan demonstrated no evidence of recurrence. However, the long-term efficacy of this procedure requires continuous observation of the patient. To the best of our knowledge, this is the first case of a giant extra-articular synovial osteochondromatosis of the proximal thigh muscle gap.

Pediatric Subtalar Joint Synovial Chondromatosis Report of a Case and an Up-to-date Review

Synovial chondromatosis is a rare, usually benign disorder affecting the population predominantly in the third and fourth decades of life and mainly involving the large weightbearing joints of the lower limb-the knees and the hip. In this report, we highlight an unusual pediatric clinical presentation of synovial osteochondromatosis involving the subtalar joint and discuss its surgical management; we also provide a comprehensive up-to-date literature review of the disorder. This patient was successfully treated with en masse surgical excision. He has been doing well, with complete pain relief and improved range of motion at 1-year follow-up. An exceptional involvement of the subtalar joint and an unusual presentation in the pediatric age group makes this case unique.