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]
Case Presentation: A 54‐year old African American man with history of dialysis‐dependent renal failure secondary to diabetes, presented with a large, painful swelling in his right buttock. [shmabstracts.com]
Entire Body System
- Pain
Case Presentation: A 54‐year old African American man with history of dialysis‐dependent renal failure secondary to diabetes, presented with a large, painful swelling in his right buttock. [shmabstracts.com]
A 57-year-old woman was referred to our pain clinic with the complaint of severe pain in the left buttock and lateral hip. [ncbi.nlm.nih.gov]
- Swelling
After 2 years of parathyroidectomy, the neck swelling again started increasing in size with increase in serum parathormone levels. [ncbi.nlm.nih.gov]
The swelling on the left shoulder ulcerated onto the skin with the discharge of chalky white material. The swellings were in variable sizes ranging from 3 to 10 cm, hard in consistency, but movable in relation to the underlying bone and skin. [ijpd.in]
Five year ago the first swelling appeared in the region of right buttock, followed by similar swellings over the left scapula and right elbow. [ijoonline.com]
- 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]
Gafni × Clinical presentation and radiographs of patient with tumoral calcinosis. ( A ) Tumoral calcinosis (arrows) of the lateral right hip at initial presentation to the NIH at 7 years, 3 months old. ( B ) Radiograph of the lesion revealed a soft tissue [jci.org]
Erosion or osseous destruction by adjacent soft-tissue is absent. [ajnr.org]
- Falling
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]
Her story was that two years earlier she had suffered a fall, receiving a blow on the left gluteal region. She attached no importance to her injury, which [jamanetwork.com]
There was a sustained fall in serum phosphate levels, but this is likely to be due to combination of better compliance with phosphate binders and low‐phosphate diet in addition to the bisphosphonate therapy. [academic.oup.com]
Uraemic tumoral calcinosis is an uncommon occurrence in patients with chronic renal failure who are on long-term haemodialysis therapy, and falls within the broad definition of tumoral calcinosis. [medical-dictionary.thefreedictionary.com]
- Epilepsy
Key words Gangliocytoma Tumor calcification Epilepsy Psychomotor fits Schlüsselwörter Gangliocytom Tumor-Verkalkung Epilepsie psychomotorische Anfälle This is a preview of subscription content, log in to check access. [link.springer.com]
[…] syndrome Diabetes Insipidus, Nephrogenic, with Mental Retardation and Intracerebral Calcification diffuse idiopathic skeletal hyperostosis + Encephalopathy with Intracranial Calcification, Growth Hormone Deficiency, Microcephaly, and Retinal Degeneration Epilepsy [rgd.mcw.edu]
Gastrointestinal
- Vomiting
Side effects during infusion included increased blood pressure (n = 1), nausea (n = 1) and vomiting (n = 1). 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. [ncbi.nlm.nih.gov]
Cardiovascular
- Hypertension
[…] describe a 44-year-old uremic female on long-term continuous ambulatory peritoneal dialysis who developed UTC in the peri-odontoid region with consequent atlantoaxial subluxation and spinal cord compression, featuring severe neck soreness, headache, and hypertension [ncbi.nlm.nih.gov]
Shortly afterward, the patient decompensated, with hypertension, bradycardia, and acute decline in motor strength in all four extremities. [appliedradiology.com]
A 62-year-old man with a history of stage 5 chronic kidney disease, type 2 diabetes mellitus, gout, and hypertension presented to the emergency department after having run out of peritoneal dialysate solution. [consultant360.com]
• Cardiac involvement (arrhythmias, cardiac insufficiency) • Pulmonary involvement (pulmonary fibrosis, pulmonary hypertension) • Musculoskeletal involvement (joint friction, arthritis, myositis, subcutaneous calcifications) • Neurological involvement [elsevier.es]
- Vascular Disease
Tumoral calcinosis (TC) is a rare familial disease characterized by abnormal peri-articular calcification in affected joints, without any associated renal, metabolic or collagen vascular disease. [ncbi.nlm.nih.gov]
The differential diagnosis includes renal osteodystrophy and collagen vascular disease. [basicmedicalkey.com]
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]
Musculoskeletal
- Fracture
Radiography and magnetic resonance imaging showed a densely calcified lesion with no periosteal reaction or fracture. The underlying bone and muscles had normal signal intensity. [ncbi.nlm.nih.gov]
The diagnosis of TIO is usually suspected when serum phosphate levels are chronically low in the setting of bone pain, fragility fractures and muscle weakness. [natureasia.com]
Heterotopic ossification in a woman with an internally fixed fracture of the posterior acetabular wall after reduction of a traumatic fracture-dislocation of the posterior hip. [pubs.rsna.org]
The Incas appear to have practiced a procedure known as trepanation since the late Stone age, during the Middle Ages in Arabia from 936 to 1013 AD, Al-Zahrawi performed surgical treatments of head injuries, skull fractures, spinal injuries, hydrocephalus [wikivisually.com]
Treatment of patholog- ical fractures of long bones excluding those due to breast cancer. [forexgrowthfunds.com]
- Back Pain
The patient presented with a 2-year history of back pain. He had no personal or family history of bone disease, deformity, or malignancy. [ncbi.nlm.nih.gov]
Materials & Methods An 83 year old female presents with back pain and was found to have a large (5 x 7 x 4 cm) multi-lobulated mass or conglomeration of masses centered about the L4/L5 facet joints. [theassr.org]
Psychiatrical
- Suggestibility
On histology sections show large calcified masses surrounded by dense fibrocollagenous tissue with mild mixed inflammatory infiltrate suggestive of tumor calcinosis [Figure 4]. [ijpd.in]
The radiologic appearance suggested a malignant neoplasm, prompting CT-guided biopsy, which diagnosed tumoral calcinosis. [ncbi.nlm.nih.gov]
In addition to the classical clinical and biochemical features of hyperphosphatemic tumoral calcinosis, the patient exhibited markedly elevated intact and C-terminal FGF23 levels, suggestive of FGF23 resistance. [jci.org]
Neurologic
- Confusion
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]
This can lead to additional confusion between radiologists and other clinicians. [theassr.org]
The aim of this report is to make the hand surgeons aware about the unusual presentation of this rare condition, which can cause a diagnostic confusion. [ispub.com]
- Meningism
Tumoral calcinosis of the lumbar meninges. Neurosurgery 2000. 47(1) 230-32. [theassr.org]
Neuroectodermal tumors: melanocytic, glial, and meningeal neoplasms Markku Miettinen; 26. Paragangliomas Markku Miettinen; 27. Primary soft tumors with epithelial differentiation Markku Miettinen; 28. [books.google.es]
It is a large, crescent-shaped fold of meningeal layer of dura mater that descends vertically in the fissure between the cerebral hemispheres of the human brain. [wikivisually.com]
- Seizure
Degeneration Epilepsy, Occipital Calcifications Facial Dysmorphism, Selective Tooth Agenesis, and Choroid Calcification Greenberg Dysplasia Hemorrhagic Destruction of the Brain, Subependymal Calcification, and Cataracts Hyperphosphatemia, Polyuria, and Seizures [rgd.mcw.edu]
- Headache
We describe a 44-year-old uremic female on long-term continuous ambulatory peritoneal dialysis who developed UTC in the peri-odontoid region with consequent atlantoaxial subluxation and spinal cord compression, featuring severe neck soreness, headache [ncbi.nlm.nih.gov]
[…] practiced a procedure known as trepanation since the late Stone age, during the Middle Ages in Arabia from 936 to 1013 AD, Al-Zahrawi performed surgical treatments of head injuries, skull fractures, spinal injuries, hydrocephalus, subdural effusions and headache [wikivisually.com]
- Paresis
We present a 70-year-old female patient with serology negative spondyloarthropathy who developed paresis due to tumoral calcinosis in the left facet joint between L5 and S1 levels and spinal epidural lipomatosis at L5 and S1 levels. [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]
X-Ray
- Muscle Calcification
Calcific myonecrosis (benign calcified mass in leg muscles). Calcific tendonitis. Calcinosis circumscripta (calcium deposits in the skin and tissue of the hands and feet). [my.clevelandclinic.org]
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
It can be considered an effective alternative treatment for tumoral calcinosis if surgical treatment is not feasible. [ncbi.nlm.nih.gov]
Nonoperative observation indications treatment of choice for non-symptomatic lesions Operative complete surgical excision indications treatment of choice for symptomatic lesions technique complete surgical excision is required to decrease the rate of [orthobullets.com]
Surgical excision of the masses has been the only partially effective treatment. [annals.org]
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]
This sub-typing is closely related to the prognosis and to the response to treatment. References 1. Maize J, Metcalf. Metabolic Diseases of the skin. In: Elder D (editor). [ijdvl.com]
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]
Outlook / Prognosis What is the outlook for someone with tumoral calcinosis? Most people with tumoral calcinosis enjoy full, active lives. It’s rare for the condition to cause serious health problems. [my.clevelandclinic.org]
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]
Etiology
TC is a disorder of obscure etiology with typical clinical, radiologic, cytologic and histopathologic features. [ncbi.nlm.nih.gov]
TERMINOLOGY Synonyms Lipid calcinosis Calcifying collagenolysis Tumoral lipocalcinosis Definitions Extraskeletal soft tissue calcification with granulomatous response ETIOLOGY/PATHOGENESIS Etiology Theories Inborn error of phosphorus metabolism Associated [basicmedicalkey.com]
Epidemiology
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]
Epidemiology Demographics more common in females and African-Americans onset in childhood or early adolescence Anatomic location around joints, primarily the hip (trochanteric bursa is most common location) > shoulder Etiology Pathophysiology unknown [orthobullets.com]
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]
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]
Epidemiology Demographics more common in females and African-Americans onset in childhood or early adolescence Anatomic location around joints, primarily the hip (trochanteric bursa is most common location) > shoulder Etiology Pathophysiology unknown [orthobullets.com]
Tumoral calcinosis revisited: pathophysiology and treatment. Rheumatol Int. 2005; 25: 55-9. Martínez S, Vogler J, Harrelson J, Lyles K. Imaging of tumoral calcinosis: new observations. Radiology. 1990; 174: 215-22. [archivo.bc.una.py]
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]
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]
Determine whether calcitonin reduces or prevents tumor recurrence. III. Determine whether hyperphosphatemia abolishes the normal circadian pattern of serum phosphorus. IV. [clinicaltrials.gov]