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Tumoral Calcinosis is a well established but rare clinical entity. It was first described in 1899, and since then, scattered reports have occurred in the literature from many parts of the world. The main controversy lies in the aetiology of the condition. One such case is presented in this paper, along with a review of the literature.
The complex of symptoms know as generalized periarticular calcinosis is a disease observed clinically as occurring in periods lasting only a few days, and with a mainly monoarticular arthritic or tenosynovitis character which may be localized in various joints. A primary chronic course of the disease is rare. Crucial for the diagnosis is the demonstration of multiple periarticular calcifications, which can be identified biochemically as hydroxyapatite. The calcification probably initiates the burst of inflammation, and for this reason the symptoms can be certainly classified pathogenically as a crystalline synovitis. Etiologically, the disease is probably due to both genetic and acquired metabolic anomalies. Modification of calcification cannot be undertaken in our present ignorance of the exact pathogenesis, and for this reason the therapy of generalized periarthritis must remain symptomatic. The effect of non-steroid antiphlogistics, corticosteroids and colchicin is, however, unsatisfactory.
Marked deposits of calcium salts were noted in the triceps and gluteal and peritrochanteric areas in a 16-yr-old girl. Blood calcium values basal and after stimulation were normal. The classification of the case as a form of pseudotumoral calcinosis universalis is discussed.
Case report of an unusual case of soft tissue calcification in the lower leg of a 50 year old patient examined for compensation problems for a gunshot fracture suffered in World War II. The differential diagnosis "localized interstitial calcinosis", "myositis ossificans" and "myositis ossificans progressiva" is being discussed.
Inclusion of dried powdered leaves of Solanum torvum Swartz (collected in Papua, New Guinea) in the diet of rats induced hypercalcaemai rapidly and hyperphosphataemia more slowly; soft tissue calcification was most evident in the kidney and lung. Solanum torvum may be a causative agent of enzootic calcinosis in cattle in Papua, New Guinea.
Samples of deposits taken from sites close to articulations in a young black African suffering from tumoral calcinosis with hyperphosphoraemia were studied by light and electron microscopy techniques. Light microscopy demonstrated lesions of a foreign body granuloma type in contact with calcium salt deposits suggesting that the process was of an active nature. Electron microscopy, and the demonstration of acid phosphatase activity, led to the identification of two cell types: mono or multinuclear macrophage type cells which phagocytose the deposit, and fibroblastic type cells. No signs of damage to the microvessels or the interstitial collagen were noted which could serve as a basis or a physiopathological explanation of the deposition. The deposits were analysed by energy dispersive X-ray microanalysis and by electron diffraction and were considered to be hydroxyapatite.
Firm multilobular subcutaneous masses were observed in two female rhesus monkeys (Macaca mulatta). Both masses were excised surgically, but reoccurred within three months. Histologically, multiple loculi of calcified material surrounded by inflammatory cells and fibrous tissue were apparent. A diagnosis of calcinosis circumscripta was made. The gross and histologic appearance of this disease resembles that reported in several species.
A new of tumoral calcinosis is described in a 91 years old woman. It is a rare condition that affect almost always black subjects. This benign disease is characterised by progressive increase of subcutaneous calcified masses near larger joints. Only four cases were yet reported in a white female.
The presence of hydroxyapatite has been determined based on ultrastructure, X-ray diffraction, electron diffraction, and chemical analysis, and confirmed by microprobe analysis in multiple deposits surgically excised from four unrelated patients with tumoral calcinosis. The chemical composition of each of the mineralized deposits resembled bone, rather than dermis, in mineral, uronic acid, total lipid, and complexed acidic phospholipid composition. No collagen abnormalities were detected. However, all of these deposits differed from normal bone mineral, being heavily mineralized and containing larger, more perfect hydroxyapatite crystals. Ultrastructurally, the crystals were both extracellular and within mononuclear cells in close proximity to dilated rough endoplasmic reticulum.
An atypical feature of a further case of salivary calcinosis reported was its exclusively unilateral parotid site. The clinical appearance was that of a pseudo-tumor following a long period of a spontaneously regressive unilateral parotid swelling. The co-existence of a Gougerot-Sjögren syndrome was confirmed clinically by the presence of a xerostomia, and radiologically by suggestive signs after a parotid sialogram. Immunological features were atypical in nature.
Clinical and histological features of idiopathic calcinosis of the scrotum are presented; calcium deposits are never associated with epithelial or connective tissue alterations. Identical lesions may arise in the skin at large; discrepancies and similitudes with cutaneous calculi are underlined.
We report two new cases of rare idiopathic nodular calcinosis of the scrotum, which is characterized by intracutaneous chalky deposits restricted to the scrotum in otherwise healthy young men. Diagnosis has to be made histologically. Therapy consists of local excision.
Clinicopathological observations of eleven cases of tumoral calcinosis are reported. All of the cases showed characteristic clinical and histopathological features of this unusual condition, but pathological findings did not elucidate all of its etiology and pathogenesis. Two of the patients were related. One of the patients showed skeletal changes characterized by diffuse calcium deposits with widespread soft-tissue calcification. The available data of the present study also led to the suggestion that the disease has a genetic background and that the primary defect may well be in the collagen which undergoes calcification.
Calcinosis circumscripta, usually associated with scleroderma, Raynaud's phenomenon, and telangiectasia, usually affects middle aged persons and is more common in females than males in a ratio of 6 to 1. The etiology is unknown, and onset of the lesion is slow and insidious. It occurs in the periarticular area as a painful mass with surrounding erythema and edema. It is visible in x-rays as localized, scattered calcification.
The localized calcinosis of the skin is an extremely rare affection, which clinically appears as a verrucous nodule. The most common locations are the face and the extremities. Histologically the calcified material is located in the subepidermal upper dermis. The epidermis is thickened with acanthosis and hyperorthokeratosis. The calcified material occurs in irregular granules and in large masses. In the Haematoxylin-Eosin-preparation its staining properties vary considerably.
A case of calcinosis localisata in the foot is presented along with a history, physical examination, ex-rays, laboratory studies, and operative report. There is a discussion of soft tissue calcification, including a concentration on types seen in the foot. In addition, a differential diagnosis is thoroughly described and treatments are discussed.
A 12-week-old pup was examined because of a bizarre periarticular joint condition. Physical, radiographic and histopathologic findings indicated synovial and periarticular calcinosis that involved virtually all of the diarthrodial joints to varying degrees. History, laboratory data, and postmortem findings tended to eliminate a nutritional, neoplastic, or infectious cause, but a genetic, endocrine, or metabolic derangement could not be ruled out.
Six siblings were screened for clinical and biochemical evidence of tumoral calcinosis. The 3 brothers showed all the characteristic manifestations of this entity. Two of them were treated for an initial period of 6 months with large doses of thyrocalcitonin, with virtually no response. After a 9-month equilibration period they were treated by phosphate depletion, and at the end of 6 months they were re-investigated. There was no appreciable objective or radiological difference in the extent of the masses. It was concluded that, in these 2 patients, surgical excision of the tumours was the only feasible form of therapy.