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.     

Tumoral calcinosis causing bone erosion in a renal dialysis patient.

Tumoral calcinosis is a rare disorder manifest by large calcific periarticular masses. Associated bone destruction has been described previously only once. The radiographic and computed tomographic (CT) findings of bone erosion in a case of tumoral calcinosis in a renal dialysis patient are presented. Although the presence of bone destruction may suggest a neoplasm, it does not exclude the diagnosis of tumoral calcinosis.     

Bone and gallium scintigraphy in a patient with bone sarcoidosis

Periosteal reaction in bone lesions in patients with sarcoidosis is rare. We report a case with this type of bone sarcoidosis in whom bone and gallium scintigraphy were useful in detecting the lesions and making the diagnosis.     

Tumoral calcinosis: radiologic-pathologic correlation

Objective Tumoral calcinosis is a frequently misdiagnosed disorder. This study details the radiologic and pathologic characteristics of tumoral calcinosis that distinguish it from most other entities.Design Radiologic and pathologic findings, and medical records of 12 patients with tumoral calcinosis were reviewed and compared with equivalent information about 5 patients with other calcified lesions.Patients The 12 patients ranged in age from 15 months to 62 years. Six had idiopathic tumoral calcinosis and 6 had secondary tumoral calcinosis.Results and conclusions A consistent radiologic finding for tumoral calcinosis was a dense calcified mass that was homogeneous except for a chicken wire pattern of lucencies, which correlated histologically with thin fibrous septae. Other characteristics of tumoral calcinosis included fluid-calcium levels, demonstrated in four patients, and smooth osseous erosions adjacent to the mass, demonstrated in three patients. Five cases of tumoral calcinosis were originally confused with other calcified lesions; however, the radiologic findings were characteristic of tumoral calcinosis in retrospect.     

Tumoral calcinosis presenting as an extradural mass: MR findings and pathological correlation

Two cases of idiopathic tumoral calcinosis presenting as an extradural mass are reported. There are few reports in the literature of this pathological process presenting as extradural masses, so both cases represent very unusual locations for tumoral calcinosis. Magnetic resonance imaging features and pathological correlation of these two cases are presented. Tumoral calcinosis might be considered as a rare but possible cause of extradural mass.     

Mass-like and extensive secondary tumoral calcinosis in the neck and body of a patient on peritoneal dialysis

We present a case of extensive tumoral calcinosis in a 42-year-old female with end-stage renal disease and secondary hyperparathyroidism on peritoneal dialysis. Periarticular calcified masses demonstrating fluid-calcium levels on computed tomography and containing chalky amorphous calcified material in the absence of neoplastic cells are the salient features of tumoral calcinosis. Although renal failure is the most common cause of secondary tumoral calcinosis, there are few reported cases of this condition occurring in patients on peritoneal dialysis. This case is also unusual due to the widespread and bulky nature of the disease with involvement of the neck and its quick onset and progression.     

肿瘤样钙质沉着症的临床和影像学分析

目的:探讨肿瘤样钙质沉着症的临床及影像学表现,提高本病的影像诊断水平.方法:回顾性分析6例经手术病理证实的肿瘤样钙质沉着症的临床及影像学资料.6例均行X线平片检查,2例行MRI检查.结果:6例患者主要临床表现为关节附近无痛性肿块,多发肿块2例,单发肿块4例.主要X线表现为关节周围团块状软组织钙化.MRI表现:T1WI上呈结节状不均匀低信号,T2WI上呈不均匀高信号.X线和MRI均显示邻近关节结构正常.结论:肿瘤样钙质沉着症的典型影像学表现为不侵及关节的软组织内多发钙化性肿块,平片和MRI有助于本病的诊断和鉴别诊断.     

Periarticular tumoral calcinosis and hypercalcemia in a hemodialysis patient without hyperparathyroidism: a case report

We present a case of a 58-yr-old male to illustrate the scintigraphic, roentgenographic, clinical, and pathologic features of periarticular tumoral calcinosis that occurred in a hemodialysis patient. Soft-tissue calcifications developed 3 yr after onset of hemodialysis, became progressively larger during the ensuing five years, and culminated in voluntary withdrawal from dialysis because of the extreme discomfort and lack of mobility that resulted from the calcinosis. Histologically, an aplastic disorder was present with very low bone formation. On bone scintigraphy, intense calcium uptake in soft tissues implied that it was metabolically active. We hypothesize that this high metabolic activity contributed to the persistent hypercalcemia observed during the patient's last year of life.     

Radiography and scintigraphy in tumoral calcinosis.

A case of tumoral calcinosis with tumoral deposits about the knee is reported. Radiographs demonstrate juxta-articular calcific deposits about the right second and fifth distal interphalangeal joints and the left first distal tuft, both hips, both shoulders, first distal phalanx of the left foot and right knee. Radionuclide images clearly demonstrate all areas of tumoral calcinosis.     

Familial tumoral calcinosis and hyperostosis–hyperphosphataemia syndrome are different manifestations of the same disease: novel missense mutations in GALNT3

Objective  

To report on the biochemistry and clinical and genetic findings of two siblings, the younger sister presenting with recurrent bone pain of the radius and ulna, and medullary sclerosis, and the older brother with soft tissue calcific deposits (tumoral calcinosis) but who later developed bone pain. Both were found to be hyperphosphaturic.     

Familial tumoral calcinosis: association with cerebral and peripheral aneurysm formation

Two siblings with histologically and radiologically proven tumoral calcinosis presented with cerebral and peripheral aneurysms. The brother died of a ruptured subclavian artery aneurysm after surgical repair of brachial, iliofemoral and coeliac axis aneurysms. Magnetic resonance and catheter angiography in the sister demonstrated marked carotid dysplasia and a left ophthalmic segment aneurysm, not amenable to treatment. We believe this is the first reported case of familial aneurysms in association with tumoral calcinosis. Received: 19 April 1998 Accepted: 6 October 1998     

Ultrasound guided aspiration of massive periarticular calcinosis in patient with scleroderma

Massive periarticular calcinosis is poorly understood process arising either primarily (tumoral calcinosis) or secondary to underlying medical conditions, including connective tissue disease, soft tissue sarcoma, and metabolic dysregulation. The calcific deposits can cause functional limitation, skin ulceration, and cosmetic deformity. Treatment of the calcific deposits depends on the underlying cause but can be problematic with resistance to surgical and non-surgical treatments. Here, we introduce a case of tumoral calcinosis secondary to scleroderma treated with ultrasound guided aspiration.     

Tumoral calcinosis of the temporomandibular joint region

A rare case of tumoral calcinosis, discovered in the medial pterygoid muscle and around the temporomandibular joint on a routine panoramic radiograph is presented. CT was found to be ideal for the determination of the exact location of the calcifications. The differential diagnosis of tumoral calcinosis is discussed.     

67Ga uptake in secondary tumoral calcinosis

Secondary tumoral calcinosis is a rare disorder that is most prevalent in patients with chronic renal failure. It is characterized by lobular densely calcified masses confined to the soft tissue, generally at the extensor surface of a joint in the anatomic distribution of a bursa. We describe a case of a 38-y-old man undergoing dialysis who presented with pyrexia of unknown origin and raised inflammatory markers but was otherwise asymptomatic. A (67)Ga scan was performed, on which an incidental diagnosis of secondary tumoral calcinosis was made.     

MR imaging findings of recurrent tumoral calcinosis

Tumoral calcinosis is an uncommon disorder and characterized by development of calcified masses within the soft tissues near the large joints. We present a recurrent tumoral calcinosis case with radiographic and magnetic resonance (MR) imaging findings.     

Tumoral calcinosis of the temporomandibular joint: CT and MR findings.

In this article, the CT, three-dimensional CT, and MR findings are reviewed in a 59-year-old woman with tumoral calcinosis involving the temporomandibular joint.     

Angiographic findings in tumoral calcinosis

Tumor calcinosis is uncommon, typically manifesting as paraarticular, extracapsular soft tissue deposits containing amorphous calcium phosphate and calcium carbonate, with associated hydroxyapatite crystal. CT and MRI are the primary diagnostic radiological tools evaluating these lesions. Primary treatment is early surgical excision with wide margins, as there is a high recurrence rate. We describe the angiographic findings in tumoral calcinosis, demonstrating hypervascularity beyond the calcified mass periphery. Exact margin definition with angiography may influence management and surgical approach.     

Tumoral calcinosis-like lesion of the proximal linea aspera

Tumoral calcinosis is presently a poorly defined disease. In its classic form, it consists of multiple large foci of benign mineralization in the soft tissue adjacent to bone near large joints. Patients are generally of African descent and are adolescents or young adults at presentation. Both metabolic and traumatic etiologies have been proposed. We report six adult Caucasian patients with lesions that pathologically resembled tumoral calcinosis. All lesions were small (less than 3 × 3 cm) and were located along the proximal linea aspera of the femur. All patients presented with pain. Because of the atypical patient population and the unusual size and location of the lesions, we refer to this process as a tumoral calcinosis-like lesion. A typical radiographic appearance and location, together with appropriate clinical history, can strongly suggest this diagnosis.     

Imaging of tumoral calcinosis: new observations

Five patients with tumoral calcinosis were evaluated with radiography, bone scintigraphy, computed tomography (CT), and magnetic resonance (MR) imaging. The arthropathy of calcium pyrophosphate dihydrate deposition disease was seen in two of the patients and pseudoxanthoma elasticum-like syndrome in three. Identification of calcific particular masses on radiographs is characteristic of tumoral calcinosis. Marrow lesions could be identified as patchy areas of calcification (calcific myelitis) in long bones and the calvarium. Bone scintigraphy appears to be the best modality for detection of the masses and marrow lesions and for monitoring therapy. At CT the masses demonstrated a varied appearance, from small and solid to large and cystic. The marrow abnormality appears as an area of increased attenuation and spotty calcification that in the skull may be associated with dural and vascular calcifications. MR imaging of the particular masses was remarkable in that the masses displayed high signal intensity on T2-weighted images despite a large calcific component. Marrow lesions also showed increased signal intensity on T2-weighted images. When calcified particular masses are present the diagnosis is rarely in question. The diagnosis may be overlooked, however, when calcific myelitis is the only manifestation.     

Somatostatin receptor scintigraphy and gallium scintigraphy in patients with sarcoidosis.

Somatostatin receptor scintigraphy (SRS) has been shown to reveal sarcoidosis sites. The aim of this study was to prospectively compare SRS and gallium scintigraphy in the evaluation of pulmonary and extrapulmonary involvement in patients with proven sarcoidosis. METHODS: Eighteen patients with biopsy-proven sarcoidosis were included. Nine were or recently had been receiving steroid therapy at the time of the examination. Planar gallium scintigraphy (head, chest, abdomen, and pelvis) and thoracic SPECT were performed at 48-72 h after injection of a mean dose of 138 +/- 21 MBq 67Ga. Planar SRS and thoracic SPECT were performed at 4 and 24 h after injection of a mean dose of 148 +/- 17 MBq 111n-pentetreotide. RESULTS: Gallium scintigraphy found abnormalities in 16 of 18 patients (89%) and detected 64 of 99 clinically involved sites (65%). SRS found abnormalities in 18 of 18 patients and detected 82 of 99 clinically involved sites (83%). Of the 9 treated patients, gallium scintigraphy found abnormalities in 7 (78%), detecting 23 of 39 clinically involved sites (59%), whereas SRS found abnormalities in 9, detecting 32 of 39 clinically involved sites (82%). CONCLUSION: This study suggests that, compared with gallium scintigraphy, SRS appears to be accurate and contributes to a better evaluation of organ involvement in sarcoidosis patients, especially those treated with corticosteroids.