肿瘤样钙质沉着症临床病理分析

目的　加深对肿瘤样钙质沉着症 (TC)临床病理特征的认识 ,提高确诊率。方法　分析 9例TC的临床、影像学、组织病理学资料。结果　TC临床诊断误诊率较高 ,9例患者中仅有 1例术前诊断正确 ,余者分别误诊为良性肿瘤 4例、异物 3例、恶性肿瘤 1例 ;而且 9例钙化区均具有典型的影像学和组织病理学特征。结论　在诊断TC过程中 ,只要注意X线摄片检查或进行病理组织活检 ,完全可以避免漏诊或误诊 ,必要时可行特殊染色或偏振光显微镜检查     

Carbonate apatite crystals in primary normophosphatemic tumoral calcinosis

A 66‐year‐old woman developed firm, painless, slowly growing nodular masses over her elbows, fingers, toes, and left hip over four years. Aspiration of the elbow mass revealed a white chalky material that was shown to be carbonate apatite on infrared spectroscopy and energy dispersive X‐ray spectroscopy. We discuss the classification of tumoral calcinosis and the nature of the calcium deposits. Tumoral calcinosis should be differentiated from tophaceous gout and calcium pyrophosphate dihydrate crystal deposition disease. Polarizing light microscopy and crystal analysis by X‐ray and infrared spectroscopy, electron or X‐ray diffraction will confirm the diagnosis. Secondary causes of tumoral calcinosis should also be excluded.     

Ultrastructural Observation of Calcification in a Pleomorphic Adenoma of the Parotid Gland

A pleomorphic adenoma was examined by electron microscopy. Calcification was found in a lumen and in epithelial cells and consisted of needle-shaped crystals that contained calcium and phosphorus and were probably apatite. Small collections of crystals in the lumen, which were often associated with membranous cellular debris, appeared to form larger calcified masses by fusion. Collections of crystals were seen in vacuoles in adluminal cells. The calcification in the lumen may have started on membranous cellular debris, and that in the adluminal cells may have arisen either by endocytosis of luminal material or by autophagocytosis. The calcification appears to relate to the old age of the tumor.     

Slipped proximal humeral epiphysis: A complication of radiotherapy to the shoulder in children

Tumoral calcinosis involves formation of periarticular calcified soft tissue masses. Experimental evidence suggests a metabolic etiology with dietary restriction of calcium and phosphorus as beneficial therapy. We prospectively monitored serum levels of calcium, phosphorous, alkaline phosphatase, and erythrocyte sedimentation rate (ESR) while successfully treating a patient with tumoral calcinosis. The values were compared with changes on serial radiographic and radionuclide bone and gallium images. Our work suggests using serial serum phosphate levels and the ESR as the most sensitive indications of progress in dietary treatment of tumoral calcinosis.     

Prevalences of CT-detected calcification in the basal ganglia in idiophathic hypoparathyroidism and pseudohypoparathyroidism

Summary Sixteen patients with idiopathic hypoparathyroidism (IHP) and eight patients with pseudohypoparathyroidism (PHP) were examined by CT scan of the brain. Calcification in the basal ganglia was observed in 11 patients with IHP (69%) and in all eight patients with PHP. Of the 19 patients with basal ganglia calcification, nine had calcification in the cerebral cortex (47%), and four had calcification in the cerebellum (21%). Observation of basal ganglia calcification on CT gave rise to suspicion of IHP or PHP in three patients (12%). The remaining patients were examined at varying time after diagnosis. Since arrest in growth of calcification after institution of treatment has never been proven, the reported prevalences of calcification may not be valid to the situation at the time of diagnosis.     

Progressive pulmonary calcification in a child after orthotopic liver transplantation

We present a case of progressive pulmonary calcification associated with prolonged respiratory insufficiency in a 2-year-old boy with a history of orthotopic liver transplantation. This case demonstrates the potentially progressive nature of pulmonary calcification and that it can present with respiratory insufficiency at a later period after transplantation than previously thought. We describe radiological findings and discuss established as well as plausible pathological mechanisms contributing to the development of calcifications in these patients.     

Intracranial calcification and tumoural calcinosis during vitamin D therapy

Extraskeletal calcifications are frequently observed in patients with chronic renal failure. However, clinically, they usually remain silent. In this report, we describe two patients with massive extraskeletal calcifications that caused significant morbidity. The first patient had tumoural calcification located on the shoulder and the second patient had severe neurological symptoms caused by intracranial calcifications. High calcium phosphorus product and severe secondary hyperparathyroidism were present in both patients. Furthermore, they both received inappropriately high doses of active vitamin D, even though they failed to respond to this therapy. We suggest to monitor closely the calcium, phosphorus and parathyroid hormone levels during calcitriol therapy and to perform parathyroidectomy, without delay, in patients who were resistant to calcitriol.     

儿童椎间盘钙化症的诊治

目的：提高儿童椎间盘钙化症的诊断及治疗水平。方法：对32例椎间盘钙化症患儿的临床症状,影像学特征进行分析。32例均住院枕颌带牵引治疗。结果：24例牵引治疗7－10例后症状完全消失,6例合并环枢关节半脱位者牵引治疗10－14天后症状完全消失。X线片显示环枢关节已复位;2例有神经受压症状者牵引治疗后症状完全消失。结论：儿童椎间盘钙化症属自限性疾病,预后良好,根据其临床表现和影像学特征,诊断并不困难,枕颌带牵引治疗效果好,即使存在神经压迫症状,仍可获得满意疗效。