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Tumoral Calcinosis
Oblique hand radiograph showing tumoral calcinosis
Presentation
- IC presents in juxta-articular tissue in a tumour-like fashion is known as idiopathic tumoral calcinosis (ITC). Recurrent trauma and chronic pressure are thought to be the triggering factors. It usually presents in adolescents and adults.[ncbi.nlm.nih.gov]
- 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.[ncbi.nlm.nih.gov]
- We present two cases of patients who presented with spinal radiculopathy and mechanical pain.[ncbi.nlm.nih.gov]
- The focus of this case report will include the presentation, radiographic examinations, clinical course, and treatment of a 90-year-old female patient presenting for evaluation of a painful plantar right foot soft tissue mass associated with chronic renal[ncbi.nlm.nih.gov]
- These tumour-like growths often infiltrate muscle and tendon, usually presenting as multiple masses or as a painless, solitary mass.[ncbi.nlm.nih.gov]
Entire Body System
Soft Tissue Mass
- The focus of this case report will include the presentation, radiographic examinations, clinical course, and treatment of a 90-year-old female patient presenting for evaluation of a painful plantar right foot soft tissue mass associated with chronic renal[ncbi.nlm.nih.gov]
- Progressively enlarging, juxta-articular, calcified, nodular soft-tissue masses Mostly occurs in 1st or 2nd decade Equal M:F Predominantly African-Americans Normal calcium and phosphorous No renal, metabolic or collagen-vascular disease Autosomal dominant[learningradiology.com]
- Presents as painful or painless soft-tissue mass. Key Diagnostic Features: Amorphous, cystic, and multilobulated calcification located in periarticular distribution.[ajnr.org]
- tissue masses with well-defined capsules and thick septae masses are filled with calcareous material (calcium phosphate, calcium carbonate and calcium hydroxyapatite) and fluid Differentials Calcinosis of renal failure (secondary tumoral calcinosis)[orthobullets.com]
- CT CT better delineates the calcific mass there is no erosion or osseous destruction by the adjacent soft-tissue masses which is another distinguishing finding of tumoral calcinosis from other pathologies It may show cystic appearance with multiple fluid-calcium[radiopaedia.org]
Soft Tissue Swelling
- Caffey disease (CD) is defined by recurrent episodes of painful soft tissue swelling and cortical thickening of the underlying bones. It is a self-limited disease that occurs in the first year of life.[ncbi.nlm.nih.gov]
- Our case report introduces two Sudanese siblings from consanguineous parents who presented with simultaneous recurrent multiple soft tissue swellings.[ncbi.nlm.nih.gov]
- An X-ray of the skull revealed chunky calcification over the area of the mass with no underlying destruction of bone, periosteal reaction, or soft tissue swelling [Figure 3]. X-ray lateral view right foot showed similar findings [Figure 4].[cjhr.org]
- It is characterized by single or multiple painless, lobular, well-demarcated periarticular soft tissue swelling/s.[ijo.in]
- Radiograph of the foot shows radiopaque soft-tissue swelling at the great toe with underlying erosive changes of the adjacent osseous structures. Figure 18. Calcific myonecrosis in a 62-year-old man with a remote history of leg trauma.[pubs.rsna.org]
Fever of Unknown Origin
- Unexpected inflammatory activity of tumoral calcinosis periarticular to the shoulders and hips in a man with recurrent fever of unknown origin and dialysis-dependent kidney insufficiency was revealed by FDG PET/CT.[ncbi.nlm.nih.gov]
- Due to the general fatigue, anorexia, fever of unknown origin and inflammatory syndrome, and considering the endemic state of TB in our country and the protein rich ascites effluent with high lymphocyte count, tuberculosis peritonitis was suspected.[sjkdt.org]
Respiratoric
Aspiration
- Aspiration cytology of this condition has been rarely reported. We describe the aspiration cytology findings of a recent case of TC and discuss possible differential diagnoses.[ncbi.nlm.nih.gov]
- A literature search revealed that this diagnosis is rarely made by touch imprint cytology of core needle biopsy and/or needle aspiration cytology, although it can be a relatively easy and straightforward diagnosis.[ncbi.nlm.nih.gov]
- We report our experience of symptomatic improvement following the repeated ultrasound-guided aspiration of calcific fluid and the injection of a mixture of local anesthetic and steroid.[ncbi.nlm.nih.gov]
- The needle aspirate showed thick whitish liquefied material which revealed amorphous, basophilic, clumps of dystrophic calcification on cytology. He was on irregular treatment and dialysis sessions.[ncbi.nlm.nih.gov]
- Subsequently about 300 ml to 500 ml viscous fluid was aspirated 5 times from the left gluteal swelling. Patient serum phosphate level decreased but lesions did not show any improvement so surgery was performed.[ijoonline.com]
Musculoskeletal
Leg Pain
- We diagnosed a case of greater trochanteric pain syndrome due to tumoral calcinosis related to chronic kidney disease in a patient whose symptoms had initially been considered to be radiating leg pain caused by lumbar spinal disease.[ncbi.nlm.nih.gov]
- View this table: In this window In a new window Case 1 An 8-year-old Saudi Arab girl presented with a 2-week history of right leg pain and fever. She had been treated at another facility with antibiotics for suspected osteomyelitis.[pediatrics.aappublications.org]
- At age 25 she had a new episode of leg pain, but this time the radiological examinations were negative, and she received no treatment. From her twenties, she has had conjunctival irritation and dental problems similar to her brother.[bmcgenet.biomedcentral.com]
Neck Pain
- A 55-year-old male with end-stage renal disease on hemodialysis presented with neck pain of 1 year's duration. A computed tomography (CT) scan was performed as part of his workup, and a posterior cervical neck mass was detected.[ncbi.nlm.nih.gov]
- A 57-year-old male presented with recurrent falls, bilateral lower-limb paresthesia, and severe neck pain. Imaging revealed a mass compressing his spinal cord. He was admitted for further workup for spinal cord compression.[ncbi.nlm.nih.gov]
- Tumoral calcinosis presenting as neck pain and lesion of the cervical spine. An J Orthop. 2008. 37: E191-5[surgicalneurologyint.com]
Torticollis
- A 5-month old presented with torticollis and a calcified cervical spinal mass. The radiologic appearance suggested a malignant neoplasm, prompting CT-guided biopsy, which diagnosed tumoral calcinosis.[ncbi.nlm.nih.gov]
- Two patients presented with occipitalgia, two patients presented with torticollis and three patients developed neurologic signs. Two patients had underlying medical conditions: One reported a history of dialysis and one had Creaste Syndrome.[surgicalneurologyint.com]
Face, Head & Neck
Neck Mass
- A computed tomography (CT) scan was performed as part of his workup, and a posterior cervical neck mass was detected. CT-guided fine needle aspiration was performed with an immediate cytologic interpretation of tumoral calcinosis.[ncbi.nlm.nih.gov]
- He recently also had a right-side neck mass that, surprisingly, was found to be extraabdominal desmoid fibromatosis on histologic examination.[ncbi.nlm.nih.gov]
- A 48-year-old woman with scleroderma and left neck mass. No history of prior trauma. No other significant contributory medical or surgical history. View Case[ajnr.org]
Neck Swelling
- After 2 years of parathyroidectomy, the neck swelling again started increasing in size with increase in serum parathormone levels.[ncbi.nlm.nih.gov]
Neurologic
Hyperalgesia
- Slight pain had developed in the left hip 3 months before the initiation of hemodialysis, which subsequently developed into hyperalgesia.[ncbi.nlm.nih.gov]
Lower Extremity Spasticity
- In this report, the authors describe the management of the first case of intramedullary TC located at the T-5 level in a 20-month-old boy who presented with lower-extremity spasticity.[ncbi.nlm.nih.gov]
Radiculopathy
- We present two cases of patients who presented with spinal radiculopathy and mechanical pain.[ncbi.nlm.nih.gov]
Workup
- A computed tomography (CT) scan was performed as part of his workup, and a posterior cervical neck mass was detected. CT-guided fine needle aspiration was performed with an immediate cytologic interpretation of tumoral calcinosis.[ncbi.nlm.nih.gov]
- He was admitted for further workup for spinal cord compression. Within 24 hours of admission, he developed upper-extremity weakness while maintaining lower-extremity function. He underwent urgent decompression of his spinal cord.[ncbi.nlm.nih.gov]
X-Ray
Muscle Calcification
- Computed tomography (CT) scan showing calcifications in an adult with HFTC including shoulder and hip soft tissue calcifications (white arrows), aortic calcification (dashed arrow), papillary muscle calcification (black arrow), and submucosal gut calcifications[ncbi.nlm.nih.gov]
Treatment
- In case 1, TC size decreased from 28.7*56.0mm at baseline to 21.5*30.6mm at M12 treatment (59% reduction). In case 2, TC reduced from 167.5*204.3mm at baseline to 86.2*85.2mm at M21 treatment (79% reduction).[ncbi.nlm.nih.gov]
- It can be considered an effective alternative treatment for tumoral calcinosis if surgical treatment is not feasible.[ncbi.nlm.nih.gov]
- For all patients, treatment with several medications before STS was unsuccessful.[ncbi.nlm.nih.gov]
- TC did not recur after treatment discontinuation with follow-up of 1.5-12 years. STS showed promising efficacy in this short series of TC. Further studies are warranted.[ncbi.nlm.nih.gov]
- Although these 2 types of TC do not differ in their radiologic and histopathologic presentations, their treatment modalities may be changed on the basis of etiology.[ncbi.nlm.nih.gov]
Prognosis
- […] milky fluid Microscopic • Nodules have large areas of amorphous or granular calcium masses • May have interspersed calcopherites • Calcium crystals exhibit hydroxyapatite • Macrophage infiltration, osteoclast-like giant cells, inflammatory cells present PROGNOSIS[tumorsurgery.org]
- Although the pathogenesis of the calcification process in tumoral calcinosis is still controversial, surgical removal remains the mainstay treatment with a satisfactory prognosis. References 1. Weiss, SW.; Goldblum, JR.[ccmbm.com]
- Infectious complications of these lesions are associated with poor prognosis. [4] Tumoral calcinosis is a rare inherited metabolic disorder characterized by massive calcium and phosphate deposits. [5] It is rare in dialyzed patients, [6] and its pathogenesis[sjkdt.org]
- It is also important to follow-up these patients as the cardiovascular prognosis is poor due to accelerated vascular calcification.[elsevier.es]
- The prognosis is usually bad. Calcinosis circumscripta has a benign course and occurs in middle-aged women. The deposits are small, nodular or streaky and affect the flexor tendon sheaths of hands and wrist.[ispub.com]
Etiology
- Although these 2 types of TC do not differ in their radiologic and histopathologic presentations, their treatment modalities may be changed on the basis of etiology.[ncbi.nlm.nih.gov]
- TC is a disorder of obscure etiology with typical clinical, radiologic, cytologic and histopathologic features.[ncbi.nlm.nih.gov]
- Subsequently, speculative etiology, differential diagnostic considerations as well as the therapeutic interventions for tumoral calcinosis are discussed taking into consideration the current literature.[ncbi.nlm.nih.gov]
- We discussed the etiology, diagnosis, and management of this condition. We report a case of a patient with cervical tumoral calcinosis with end-stage renal disease.[ncbi.nlm.nih.gov]
- The etiology of this pathology is still not well understood but degenerative spine diseases seem to play a role.[ncbi.nlm.nih.gov]
Epidemiology
- Introduction Rare and poorly understood hereditary metabolic dysfunction of phosphate regulation associated with massive periarticular calcinosis in the extra-capsular soft tissues Epidemiology demographics more common in females and African-Americans[orthobullets.com]
- Chondrocalcinosis Allowable Qualifiers English : BL blood CF cerebrospinal fluid CI chemically induced CL classification CO complications CN congenital DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology[decs.bvs.br]
Sex distribution
Age distribution
Pathophysiology
- Identification of this pathophysiology extends the etiologic spectrum of hyperphosphatemic tumoral calcinosis and suggests that immunomodulatory therapy may be an effective treatment. Authors Mary Scott Roberts, Peter D.[jci.org]
- […] calcinosis in the extra-capsular soft tissues Epidemiology demographics more common in females and African-Americans onset in childhood or early adolescence location around joints, primarily the hip ( trochanteric bursa is most common location) shoulder Pathophysiology[orthobullets.com]
- The recent identification of a fusion of fibronectin and fibroblast growth factor receptor 1 (FGFR1) as a molecular driver in some tumours not only sheds light on the pathophysiology of TIO but also opens the door to a better understanding of the transcription[natureasia.com]
- Tumoral calcinosis revisited: pathophysiology and treatment. Rheumatol Int. 2005; 25(1):55-9. 7. Kim HS, Suh JS, Kim YH, Park SH. Tumoral calcinosis of the hand: three unusual cases with painful swelling of small joints.[oapublishinglondon.com]
- Pathophysiology Deficiency of or resistance to FGF23 leads to hyperphosphatemia resulting in increased renal phosphate reabsorption and elevated or inappropriately normal 1,25D production, which promotes gastrointestinal absorption of phosphorus and calcium[ncbi.nlm.nih.gov]
Prevention
- A concise review of the pertinent literature focusing on the diagnosis, treatment options, and preventive measures also is reported. This journal requires that authors assign a level of evidence to each article.[ncbi.nlm.nih.gov]
- The diagnosis of tumoral calcinosis preoperatively can prevent intraoperative confusion from unexpected findings, especially in cases where removal of the calcified mass is essential to treating the patient's symptoms, i.e. nerve compression causing radiculopathy[ncbi.nlm.nih.gov]
- Being aware of the possibility and having knowledge of tumoral calcinosis is paramount in preventing confusion and delay in diagnosis for patients and clinicians.[ncbi.nlm.nih.gov]
- The GALNT3 gene encodes GalNAc-T3, which prevents degradation of the phosphaturic hormone, fibroblast growth factor 23 (FGF23).[ncbi.nlm.nih.gov]
- Determine whether calcitonin reduces or prevents tumor recurrence. III. Determine whether hyperphosphatemia abolishes the normal circadian pattern of serum phosphorus. IV.[clinicaltrials.gov]