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Ayoub E, Youssef B, Badr B, Meriem OI, Najate CIE. Tumoral calcinosis producing peripheral nerve compression of the suprascapular nerve: A case report. Radiol Case Rep 2025; 20:670-673. [PMID: 39583241 PMCID: PMC11585465 DOI: 10.1016/j.radcr.2024.09.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 09/16/2024] [Accepted: 09/19/2024] [Indexed: 11/26/2024] Open
Abstract
Tumoral calcinosis is a rare disorder characterized by the deposition of calcium phosphate crystals in periarticular soft tissues, often presenting as asymptomatic masses. However, these calcific masses can occasionally cause significant morbidity by compressing adjacent neurovascular structures. We report a rare case of tumoral calcinosis leading to peripheral nerve compression of the suprascapular nerve in a 55-year-old female. The patient presented with progressive shoulder pain and weakness, significantly affecting her daily activities. Imaging studies, including X-ray, CT, and MRI, revealed large, calcified masses in the scapular region compressing the suprascapular nerve. This case highlights the importance of considering nerve compression in the differential diagnosis of shoulder pain with muscular weakness in tumoral calcinosis. Surgical decompression of the nerve and excision of the calcified masses resulted in significant pain relief and partial recovery of shoulder function. This report underscores the critical role of imaging in the diagnosis and management of tumoral calcinosis and the potential for favorable outcomes with timely surgical intervention.
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Affiliation(s)
- Elhajjami Ayoub
- Department of Radiology, Caddi Ayyad University, Arrazi Hospital, Marrakech University Hospital, Marrakech, Morocco
| | - Bouktib Youssef
- Department of Radiology, Caddi Ayyad University, Arrazi Hospital, Marrakech University Hospital, Marrakech, Morocco
| | - Boutakioute Badr
- Department of Radiology, Caddi Ayyad University, Arrazi Hospital, Marrakech University Hospital, Marrakech, Morocco
| | - Ouali Idrissi Meriem
- Department of Radiology, Caddi Ayyad University, Arrazi Hospital, Marrakech University Hospital, Marrakech, Morocco
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2
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Waltenspül C, Spies CK, Janzen J. Tumoral Calcinosis at a Finger Metacarpophalangeal Joint. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024. [PMID: 38977005 DOI: 10.1055/a-2324-6535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
A 51-year-old patient presented with a painful swelling palmar to the metacarpophalangeal joint of the ring finger. A round tumor was detected using X-rays and MRI. After excision, tumoral calcinosis could be verified histologically.
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Affiliation(s)
| | | | - Jan Janzen
- Histopathologie und VascPath, Gümligen, Schweiz
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3
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Ivanova NG. A Sole Case of the FGF23 Gene Mutation c.202A>G (p.Thr68Ala) Associated with Multiple Severe Vascular Aneurysms and a Hyperphosphatemic Variant of Tumoral Calcinosis-A Case Report. Life (Basel) 2024; 14:613. [PMID: 38792634 PMCID: PMC11123361 DOI: 10.3390/life14050613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Tumoral calcinosis is an extremely rare genetic disease caused by mutations in three genes, GALNT3, FGF23, and KL, which disrupt phosphorus metabolism. The hallmark of this condition is the formation of tumors in the soft tissues around the joints. Other phenotypic features of tumoral calcinosis are dental involvement and brain and vascular calcifications. The clinical case reported herein presents for the first time to the scientific community the c.202A>G (p.Thr68Ala) mutation of the FGF23 gene, associated with a hyperphosphatemic variant of tumoral calcinosis and multiple severe vascular aneurysms. A female patient underwent multiple surgeries for tumor formations in her soft tissues that first appeared at the age of 12 months. On this occurrence, the patient was found to have hyperphosphatemia, low phosphate clearance, increased tubular reabsorption with normal levels of total and ionized calcium, vitamin D3, and parathyroid hormone, and no effect of treatment with sevelamer hydrochloride and a low-phosphate diet. At the age of 39, the patient underwent imaging studies due to edema and a pulsating formation in the neck area, which revealed multiple vascular aneurysms with thrombosis, for which she received operative and interventional treatment. In this connection, and because of the established phosphorus metabolism disturbance, a genetic disease was suspected. The sequence analysis and deletion/duplication testing of the 358 genes performed on this occasion revealed that the woman was homozygous for a variant of the c.202A>G (p.Thr68Ala) mutation of the FGF23 gene. The established mutation is not present in population databases. The presented clinical case is the first and only one in the world to demonstrate the role of this type of FGF23 gene mutation in the development of a hyperphosphatemic variant of tumoral calcinosis characterized by aggressive formation of multiple vascular aneurysms.
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Affiliation(s)
- Nevena Georgieva Ivanova
- Department of Urology and General Medicine, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria; ; Tel.: +35-98-8913-0416
- St Karidad MHAT, Karidad Medical Health Center, 4004 Plovdiv, Bulgaria
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4
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Grosvenor EM, Flower C. Sedimentation Sign in Tumoral Calcinosis in Systemic Sclerosis. J Clin Rheumatol 2024; 30:e68. [PMID: 37936272 DOI: 10.1097/rhu.0000000000002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Affiliation(s)
- Ebonii-Mykel Grosvenor
- From the Faculty of Medical Sciences, University of the West Indies at Cave Hill, Cave Hill, Barbados
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5
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Tsukamoto S, Errani C, Facchini F, Papagelopoulos P, Mavrogenis AF. Fluid-fluid Levels in Musculoskeletal Tumor Imaging. Curr Med Imaging 2021; 17:157-165. [PMID: 32767947 DOI: 10.2174/1573405616666200806173258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022]
Abstract
Fluid-fluid levels result from the separation of two fluids of differing densities within a cavernous space with the boundary between the two layers running in a horizontal plane at 90 degrees to the direction of gravity. Magnetic resonance imaging is the most sensitive imaging modality to identify fluid-fluid levels. Although the most common bone lesions containing fluid-fluid levels are aneurysmal bone cyst and telangiectatic osteosarcoma, fluid-fluid levels can be observed in a wide variety of bone and soft tissue lesions. Therefore, fluid-fluid levels cannot be considered diagnostic of any particular type of tumor and the diagnosis should be made on the basis of other clinical, radiological and pathological findings. This article summarizes the pathophysiology and imaging characteristics of fluid-fluid levels and discusses the differential diagnosis of tumors with this imaging sign.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Costantino Errani
- Department Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Fabio Facchini
- Intensive Care and Pain Therapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Panayiotis Papagelopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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6
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Chebbi W, Belhaj G, Messaoud AB. Tumoral calcinosis: a rare disease. LA TUNISIE MEDICALE 2021; 99:306-310. [PMID: 33899204 PMCID: PMC8715796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Idiopathic tumoral calcinosis is a rare affection. It is defined by the presence of calcified deposits in periarticular tissues. The diagnosis is suspected on imaging and confirmed by histology. The treatment consists of a precocious and complete surgical exeresis. Despite the risk of recidivism, the prognosis is always excellent. We report a new case of tumoral calcinosis in a patient of the fifties and clear phototype. The clinical exam found a voluminous mass of soft tissues and the radiological exam showed the presence of voluminous periarticular calcifications with no bone involvement. The diagnosis was confirmed by the anatomopathological exam. The treatment remains essentially surgical.
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Affiliation(s)
- Wael Chebbi
- Centre de traumatologie et des grands brûlés / faculté de médecine de Tunis
| | - Ghassen Belhaj
- Centre de traumatologie et des grands brûlés / faculté de médecine de Tunis
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7
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Mooney MA, Oppenlander ME, Kakarla UK, Theodore N. Tumoral calcinosis of the craniovertebral junction as a cause of dysphagia with treatment by transoral decompression: case report. J Neurosurg Spine 2017; 26:567-571. [PMID: 28186471 DOI: 10.3171/2016.9.spine16469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Tumoral calcinosis is characterized by tumor-like deposition of calcium in periarticular soft tissue. Spinal involvement is rare, and perioperative diagnosis of tumoral calcinosis can be difficult because lesions may be confused with bony neoplasms. Symptoms of tumoral calcinosis result from bony involvement and/or direct compression of surrounding anatomical structures, for which treatment with surgical decompression can be highly successful. The craniovertebral junction is rarely affected by tumoral calcinosis, and patients with this condition may present with distinct symptoms. Herein, to their knowledge the authors present the first case of tumoral calcinosis affecting the craniovertebral junction in a patient who presented with severe dysphagia and required transoral decompression. Recognition of tumoral calcinosis by neurosurgeons is essential for facilitating diagnosis and treatment, and the transoral approach is an effective method for decompression in select patients.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark E Oppenlander
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Abstract
We report a case of a 55-year-old woman with chronic renal failure and secondary tumoral calcinosis with rare intraosseous penetration of the humerus. Typical lobulated calcifications with associated layering “milk of calcium” were present about the right shoulder and elbow on conventional radiographs, computed tomography images and magnetic resonance images. Rare appearance of cortical destruction and intraosseous extension of tumoral calcinosis into the medullary space was observed in the proximal humerus on CT and MR images. Since there is concern for pathologic fracture, radiologists should be aware of this rare complication of chronic renal disease.
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9
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Fathi I, Sakr M. Review of tumoral calcinosis: A rare clinico-pathological entity. World J Clin Cases 2014; 2:409-414. [PMID: 25232542 PMCID: PMC4163761 DOI: 10.12998/wjcc.v2.i9.409] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/08/2014] [Accepted: 06/27/2014] [Indexed: 02/05/2023] Open
Abstract
Tumoral calcinosis (TC) has long been a controversial clinico-pathological entity. Its pathogenesis and genetic background have been gradually unravelled since its first description in 1943. According to the presence or absence of an underlying calcifying disease process, TC has been divided into primary and secondary varieties. Two subtypes of the primary variety exist; a hyper-phosphatemic type with familial basis represented by mutations in GalNAc transferase 3 gene (GALNT3), KLOTHO or Fibroblast growth factor 23 (FGF23) genes, and a normo-phosphatemic type with growing evidence of underlying familial base represented by mutation in SAMD9 gene. The secondary variety is mainly associated with chronic renal failure and the resulting secondary or tertiary hyperparathyroidism. Diagnosis of TC relies on typical radiographic features (on plain radiographs and computed tomography) and the biochemical profile. Magnetic resonance imaging can be done in difficult cases, and scintigraphy reflects the disease activity. Treatment is mainly surgical for the primary variety; however, a stage-oriented conservative approach using phosphate binders, phosphate restricted diets and acetazolamide should be considered before the surgical approach is pursued due to the high rate of recurrences and complications after surgical intervention. Medical treatment is the mainstay for treatment of the secondary variety, with failure warranting subtotal or total parathyroidectomy. Surgical intervention in these patients should be kept as a last resort.
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Balachandran K, Kamalanathan S, Sahoo JP, Das AK, Halanaik D. Differential response of idiopathic sporadic tumoral calcinosis to bisphosphonates. Indian J Endocrinol Metab 2014; 18:521-525. [PMID: 25143910 PMCID: PMC4138909 DOI: 10.4103/2230-8210.137511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Tumoral calcinosis is a disorder of phosphate metabolism characterized by ectopic calcification around major joints. Surgery is the current treatment of choice, but a suboptimal choice in recurrent and multicentric lesions. AIMS To evaluate the efficacy of bisphosphonates for the management of tumoral calcinosis on optimized medical treatment. SETTINGS AND DESIGN The study was done in the endocrine department of a tertiary care hospital in South India. We prospectively studied two patients with recurrent tumoral calcinosis who had failed therapy with phosphate lowering measures. MATERIALS AND METHODS After informed consent, we treated both patients with standard age adjusted doses of bisphosphonates for 18 months. The response was assessed by X ray and whole body 99mTc-methylene diphosphonate bone scan at the beginning of therapy and at the end of 1 year. We also estimated serum phosphate levels and urinary phosphate to document serial changes. RESULTS Two patients (aged 19 and 5 years) with recurrent idiopathic hyperphosphatemic tumoral calcinosis, following surgery were studied. Both patients had failed therapy with conventional medical management - low phosphate diet and phosphate binders. They had restriction of joint mobility. Both were given standard doses of oral alendronate and parenteral pamidronate respectively for more than a year, along with phosphate lowering measures. At the end of 1 year, one of the patients had more than 95% and 90% reduction in the size of the lesions in right and left shoulder joints respectively with total improvement in range of motion. In contrast, the other patient (5-year-old) had shown no improvement, despite continuing to maintain normophosphatemia following treatment. CONCLUSIONS Bisphosphonate therapy in tumoral calcinosis is associated with lesion resolution and may be used as a viable alternative to surgery, especially in cases with multicentric recurrence or treatment failure to other drugs.
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Affiliation(s)
- Karthik Balachandran
- Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Sadishkumar Kamalanathan
- Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Jaya Prakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ashok Kumar Das
- Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Dhanapathi Halanaik
- Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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11
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Affiliation(s)
- Wai Kan Tsang
- Department of Radiology & Nuclear Medicine, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong,
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12
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Del Bravo V, Liuzza F, Perisano C, Chalidis B, Marzetti E, Colelli P, Maccauro G. Gluteal tumoral calcinosis. Hip Int 2012; 22:585-591. [PMID: 23233180 DOI: 10.5301/hip.2012.10347] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2012] [Indexed: 02/04/2023]
Abstract
Tumoral calcinosis is an extremely rare benign condition that is characterised by deposits of calcium hydroxyapatite crystals in periarticular soft tissues. Although it is mainly located around large joints such as the hips, shoulders and elbows, it may also involve the small joints of hand and wrist. There are multiple types of tumoral calcinosis with divergent clinical characteristics but the exact cause is still unknown. We present a literature review to evaluate the location, clinical features, treatment options and results of surgical excision in this condition. Wide resection appears to lead to a good clinical outcome and a low incidence of local relapse.
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Affiliation(s)
- Valentina Del Bravo
- Department of Orthopaedics and Traumatology, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
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13
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Farrow EG, Imel EA, White KE. Miscellaneous non-inflammatory musculoskeletal conditions. Hyperphosphatemic familial tumoral calcinosis (FGF23, GALNT3 and αKlotho). Best Pract Res Clin Rheumatol 2011; 25:735-47. [PMID: 22142751 PMCID: PMC3233725 DOI: 10.1016/j.berh.2011.10.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 10/13/2011] [Indexed: 11/18/2022]
Abstract
Familial tumoral calcinosis (TC) is a rare disorder distinguished by the development of ectopic and vascular calcified masses that occur in settings of hyperphosphatemia (hFTC) and normophosphatemia (nFTC). Serum phosphorus concentrations are relatively tightly controlled by interconnected endocrine activity at the level of the intestine, kidney, and skeleton. Discovering the molecular causes for heritable forms of hFTC has shed new light on the regulation of serum phosphate balance. This review will focus upon the genetic basis and clinical approaches for hFTC, due to genes that are related to the phosphaturic hormone fibroblast growth factor-23 (FGF23). These include FGF23 itself, an FGF23-glycosylating enzyme (GALNT3), and the FGF23 co-receptor α-Klotho (αKL). Our understanding of the molecular basis of hFTC will, in the short term, aid in understanding normal phosphate balance, and in the future, provide potential insight into the design of novel therapeutic strategies for both rare and common disorders of phosphate metabolism.
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Affiliation(s)
- Emily G. Farrow
- Departments of Medical and Molecular Genetics, IN, 46202 USA
| | - Erik A. Imel
- Medicine Indiana University School of Medicine Indianapolis, IN, 46202 USA
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14
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Van Hul E, Vanhoenacker F, Van Dyck P, De Schepper A, Parizel PM. Pseudotumoural soft tissue lesions of the foot and ankle: a pictorial review. Insights Imaging 2011; 2:439-452. [PMID: 22347966 PMCID: PMC3259410 DOI: 10.1007/s13244-011-0087-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 02/15/2011] [Indexed: 12/19/2022] Open
Abstract
In the foot and ankle region, benign neoplasms and pseudotumoural soft tissue lesions are significantly more frequent than malignant tumours. The pseudotumoural lesions constitute a heterogeneous group, with highly varied aetiology and histopathology. This article reviews the imaging features of the most common pseudotumours of the soft tissues in the foot and ankle. Although the imaging characteristics of several of the lesions discussed are non-specific, combining them with lesion location and clinical features allows the radiologist to suggest a specific diagnosis in most cases.
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15
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Hodnett P, Moore M, Kinsella S, Kelly D, Plant WD, Maher MM. Radiological features of progressive tumoral calcinosis in chronic renal failure. ACTA ACUST UNITED AC 2007; 51 Spec No.:B115-8. [PMID: 17875130 DOI: 10.1111/j.1440-1673.2007.01788.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present the case of a young adult patient with chronic renal failure who developed painful subcutaneous nodules after failed renal transplant and recommencing dialysis. These nodules were juxta-articular in location and initially located over both shoulders. Radiological evaluation suggested tumoral calcinosis. The patient was placed on a strict dialysis and dietary regimen but was suboptimally compliant with same. The patient developed progressive disease with an increase in size and number of juxta-articular calcified soft-tissue masses. However, 6 months following a second renal transplant clinical and radiological follow up demonstrated marked resolution both in symptomatology and radiographic findings. We present the plain radiographic, CT and MRI findings which demonstrate the typical radiological features of tumoral calcinosis. We correlate these findings with clinical course and histological findings following surgical excision of one of these masses.
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Affiliation(s)
- P Hodnett
- Radiology Department, Cork University Hospital, Cork, Ireland.
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16
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Abstract
Tumoral calcium pyrophosphate dihydrate crystal deposition disease and tumoral calcinosis (TC) are rare non-neoplastic conditions which may cause symptoms of spinal cord compression when they manifest in the perispinal tissues. There is little information available to compare these conditions with each other. We report a case of a patient with such a calcified mass impinging on the spinal cord. A 39-year-old woman on hemodialysis presents with progressive quadriparesis and monoplegia and is found to have a large calcified mass impinging on the spinal cord at the level of C3-4. The mass is excised by an anterior approach with corpectomy and fusion. Pathology was tumoral calcium pyrophosphate dihydrate crystal deposition disease versus TC. Both conditions are very rare in the perispinal tissues with 21 reported cases of tumoral calcium pyrophosphate dihydrate deposition disease and 39 cases of TC. Both cause compressive symptoms depending on the site of occurrence. Tumoral calcium pyrophosphate deposition disease is characterized by smaller, round, masses typically in ligamentous structures which may erode into adjacent bone. Tumoral calcinosis displays larger, lobulated, irregular lesions which do not erode into bone. Either lesion may contain calcium pyrophosphate dihydrate or hydroxyapatite. Treatment is surgical decompression, though lesions may recur.
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Affiliation(s)
- Andrew P Carlson
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA
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17
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Mathieu G, Lemonne F, Flouzat-Lachaniette CH, Sedel L. [Idiopathic tumoral calcinosis: two cases and review of the literature]. ACTA ACUST UNITED AC 2006; 92:358-63. [PMID: 16948463 DOI: 10.1016/s0035-1040(06)75766-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two black patients from Africa presented idiopathic tumoral calcinosis. This rare disease, defined by the presence of calcified deposits in peri-articular tissues remains poorly elucidated. Pathogenesis is still hypothetical. The diagnosis can be established with careful physical examination and appropriate complementary exams, allowing early complete surgical resection without biopsy. Pathology examination is required for formal differential diagnosis. The present tumors were particularly large, but did not produce signs of compression. In the first patient, the tumor developed after pregnancy in the zone of antibiotic injections. The second patient presented multiple bilateral symmetrical localizations with bone invasion. Histology confirmed the nature of the lesions and revealed bony metaplasie in the first patient, an element rarely described. Prognosis is excellent with early treatment. Recurrence is the rule in the event of incomplete resection. We discuss the appropriate diagnostic and therapeutic management.
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Affiliation(s)
- G Mathieu
- Service d'Orthopédie et de Traumatologie, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris Cedex 10.
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18
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Abstract
Massive periarticular calcinosis of the soft tissues is a unique but not rare radiographic finding. On the contrary, tumoral calcinosis is a rare familial disease. Unfortunately, the term tumoral calcinosis has been liberally and imprecisely used to describe any massive collection of periarticular calcification, although this term actually refers to a hereditary condition associated with massive periarticular calcification. The inconsistent use of this term has created confusion throughout the literature. More important, if the radiologist is unfamiliar with tumoral calcinosis or disease processes that mimic this condition, then diagnosis could be impeded, treatment could be delayed, and undue alarm could be raised, possibly leading to unwarranted surgical procedures. The soft-tissue lesions of tumoral calcinosis are typically lobulated, well-demarcated calcifications that are most often distributed along the extensor surfaces of large joints. There are many conditions with similar appearances, including the calcinosis of chronic renal failure, calcinosis universalis, calcinosis circumscripta, calcific tendonitis, synovial osteochondromatosis, synovial sarcoma, osteosarcoma, myositis ossificans, tophaceous gout, and calcific myonecrosis. The radiologist plays a critical role in avoiding unnecessary invasive procedures and in guiding the selection of appropriate tests that can result in a conclusive diagnosis of tumoral calcinosis.
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Affiliation(s)
- Kathryn M Olsen
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1088, USA
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19
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Sebesta A, Kamineni S, Dumont CE. Idiopathic tumoral calcinosis of the index finger. Case report. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 2000; 34:405-8. [PMID: 11195883 DOI: 10.1080/028443100750059237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Tumoral calcinosis of the hand is rare, and we present a case report of idiopathic tumoral calcinosis of the index finger, which posed a diagnostic problem as it looked like an infection. We successfully removed the calcific deposit and there had been no recurrence one year after the operation.
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Affiliation(s)
- A Sebesta
- Department of Orthopaedic Surgery, University of Zürich, Switzerland
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20
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McGuinness FE. Hyperphosphataemic tumoral calcinosis in Bedouin Arabs--clinical and radiological features. Clin Radiol 1995; 50:259-64. [PMID: 7729126 DOI: 10.1016/s0009-9260(05)83482-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the first report of Bedouin Arabs with tumoral calcinosis, three Saudi Arabian male siblings and their female first cousin with the condition are described. In tumoral calcinosis the majority of cases are familial. These patients had associated hyperphosphataemia with normal renal function. The characteristic appearance of periarticular soft tissue calcified masses was present. Two of the cases developed calcific myelitis of long bones--a recognized complication of the disease. Two have widespread arterial calcification, which has not previously been described. Two cases have other unusual features; one has a calcified mass which has destroyed the blade of the scapula, whilst another developed a large tumoral mass on the posterior aspect of the knee.
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Affiliation(s)
- F E McGuinness
- Department of Diagnostic Imaging, King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia
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21
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Mitsudomi T, Tateishi M, Oka T, Nishino T, Ishida T, Sugimachi K. Dorsal mass in hyperparathyroidism secondary to chronic renal failure. Ann Thorac Surg 1989; 48:426-7. [PMID: 2774732 DOI: 10.1016/s0003-4975(10)62873-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 65-year-old man had metastatic calcification forming a huge mass located on the dorsum. The calcified mass extended into the thoracic cavity and was removed; the sixth rib was also resected. Diagnosis and treatment are discussed.
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Affiliation(s)
- T Mitsudomi
- Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Affiliation(s)
- M Zawin
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06510
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Abstract
Tumoral calcinosis rarely occurs in the hand. It is an uncommon familial disease suggesting an autosomal recessive gene pattern, often with laboratory findings of hyperphosphatemia and normocalcemia. Our patient had bilateral hand involvement, including local calcinosis cutis of the skin and bone changes not previously reported in the literature. At a 2-year follow-up after two lesions were excised from her left hand, one lesion had completely resolved and the other recurred. Two large symptomatic lesions and one area of local calcinosis cutis in her right hand have recently been excised.
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Abstract
Tumoral calcinosis is an uncommon, usually solitary, tumour-like mass characterized by soft tissue calcification for no apparent reason. Nearly all cases have occurred in negroes, including 2 previously recorded in this country. We report 7 cases seen over a period of 3 years in English caucasian patients and suggest that the condition is not rare but goes unrecognized under a variety of guises. Three of these 7 patients, 2 of whom were on haemodialysis for renal failure, had isolated hyperphosphataemia, which is the only aetiological factor detected so far. Surgical excision appears to be the only effective treatment.
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Abstract
A case of tumoral calcinosis is presented. The characteristic clinical, radiologic, and pathologic features of this uncommon disease are described and the various speculations about its etiology are examined, based on a review of the approximately 150 cases which comprise the world literature concerning this disease. The differential diagnosis of periarticular calcified soft tissue masses is discussed.
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Schoenfeld A, Edelstein T, Joel-Cohen SJ. Prenatal ultrasonic diagnosis of fetal teratoma of the neck. Br J Radiol 1978; 51:742-4. [PMID: 698522 DOI: 10.1259/0007-1285-51-609-742] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Smith FW, Junor BJ. Peri-articular calcification with fluid levels in secondary hyperparathyroidism. Br J Radiol 1978; 51:741-2. [PMID: 698521 DOI: 10.1259/0007-1285-51-609-741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Hall AJ, Railton R. Letter: The importance of the brilliance control in grey scale echography. Br J Radiol 1975; 48:320-1. [PMID: 1131491 DOI: 10.1259/0007-1285-48-568-320-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Kolawole TM, Bohrer SP. Tumoral calcinosis. Br J Radiol 1975. [DOI: 10.1259/0007-1285-48-568-320-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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