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.     

多层螺旋CT重组技术对肿瘤样钙质沉着症诊断的价值

目的探讨多层螺旋CT(multi-slice spiral CT,MSCT)重组技术在肿瘤样钙质沉着症诊断中的应用价值。方法经手术病理证实的肿瘤样钙质沉着症7例,男性3例,女性4例,年龄20～54岁,平均30.5岁7,例行X线,6例行轴位CT检查并全部行图像后处理,3例行MRI检查。分析肿瘤样钙质沉着症的各种影像学表现,并与病理对照。结果 7例肿瘤样钙质沉着症均表现为软组织内不规则致密钙化斑。7例中X线平片明确诊断4例(57.14%),CT横轴位图像结合后处理图像明确诊断7例(100.00%),MRI均未作出明确诊断(0.00%)。结论 MSCT重组技术对钙质沉着症的定位、定性具有重要的临床诊断价值。     

超声对小儿肾钙质沉着症的诊断价值

目的探讨超声对小儿钙质沉着的诊断价值。方法回顾性分析1986年1月～2009年10月超声检查诊断肾钙质沉着56例,与临床资料之间对比分析。结果 56例钙质沉着的病例中,30例临床诊断为肾小管酸中毒;5例肾脏结石;4例为VitD中毒;3例为急性肾炎;甲状旁腺功能亢进及假性甲状旁腺功能减低各1例;12例病因不明确。结论超声能发现小儿肾钙质沉着症,为临床诊断提供依据。     

Tumoral calcinosis associated with sarcoidosis and positive bone and gallium imaging

A 63-year-old female with biopsy proven tumoral calcinosis presented with progressive and recurrent swelling and tenderness of the right hip, thigh, elbow, and wrist. Both gallium and bone imaging demonstrated intense, congruent uptake in these areas. This is the third case of tumoral calcinosis with sarcoidosis documented in the literature. However, these are the first published bone and gallium scans in a patient with a history of sarcoidosis and 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.     

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.     

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.     

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.     

Diffuse soft tissue calcification in tumoral calcinosis

Tumoral calcinosis is a rare disease characterized biochemically by hyperphosphatemia, normocalcemia, and reduced fractional excretion of phosphate. Radiographically, it has been defined by the presence of large, amorphous juxtaarticular calcific deposits. A 53-year-old woman with tumoral calcinosis was found to have unusual diffuse soft tissue calcification indistinguishable from that usually seen in collagen vascular disease and previously referred to as calcinosis universalis. It is suggested that tumoral calcinosis is a misnomer as the calcification seen in patients with this disease may be tumoral or diffuse.     

Calcinosis in juvenile dermatomyositis

A retrospective study of the radiographs and clinical records of 39 children with dermatomyositis, followed up at a referral centre for a mean period of eight years, revealed calcinosis in 29 children (18 giris, 11 boys). Clinical presentation of calcinosis was unpredictable and variable, ranging from four months to 12 years after onset of disease. Subcutaneous calcilication, often associated with subsequent ulceration of overlying skin, was observed more frequently than calcinosis in intermuscular fascial planes (29:7). Subcutaneous calcinosis was demonstrated most commonly about the knees and elbows and in the fingers and toes. Intermuscular calcinosis affected the fascial planes around the quadriceps, deltoid, biceps, and the gastrocnemius/soleus muscles.Calcinosis, predominantly of the subcutaneous lesions, regressed spontaneously in eight of 11 children where this could be assessed over a one to four year period. This high rate of spontaneous resolution must complicate evaluation of the efficacy of proposed anti-calcinotic treatments in juvenile dermatomyositis.While no apparent relationship was established between subcutaneous calcinosis, which was present in all 29 of the affected patients, and disease activity or severity, all seven children with the additional, extensive, and classical intermuscular fascial plane calcification developed this complication early and had severe disease.These findings are discussed in relation to previous studies.     

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.     

Evaluation of soft-tissue calcifications in dermatomyositis with 99mTc-phosphate compounds: case report.

A whole-body scan with 99mTc-pyrophosphate and 85Sr-nitrate demonstrates extension of calcinosis in one case of dermatomyositis with cutaneous, subcutaneous, and muscular calcinosis. The authors suggest the potential use of 99mTc-phosphate compounds as an auxiliary instrument in the evaluation of dermatomyositis-polymyositis syndrome.     

The radiographic changes of scleroderma in the hands

Hand radiographs from 160 patients with scleroderma were reviewed. The presence of calcinosis distal to the metacarpophalangeal joints was significantly associated with the female sex, disease duration over 10 years, digital ulceration, telangiectasia, tuft erosion and the presence of anticentromere antibodies. The presence of calcinosis proximal to the metacarpophalangeal joints was significantly associated with tuft erosions and erosions involving all joints. The lack of distal calcinosis was significantly associated with anti Scl 70 and antinucleolar antibodies. The prevalence of other radiological manifestations of scleroderma such as osteoarthritis, erosions and dorsal tuft modelling was documented. Specific radiological findings correlate with certain clinical and serological characteristics in scleroderma.     

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.     

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.     

Disproportionately severe calcinosis cutis in an 88-year-old patient with CREST syndrome

An 88-year-old woman with CREST syndrome (calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias) presented with hyperglycemia, intravascular depletion, and atrial fibrillation. The patient was found to have unusually severe calcinosis cutis in both legs extending from the knees to the ankles bilaterally, as well as Raynaud’s phenomenon, sclerodactyly, and telangiectasias. The patient was normocalcemic and normophosphatemic. Although subcutaneous calcification is often seen with CREST syndrome, this case is unusual in that the area of involvement was much larger than previously described. Furthermore, the amount of calcinosis was disproportionately severe and was the major cause of symptoms and disability compared with the other components of the syndrome. Received: 1 February 2001 Revision requested: 21 March 2001 Revision received: 3 April 2001 Accepted: 4 April 2001     

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     

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.     

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.     

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.