A Rare Case of Tumoral Calcium Pyrophosphate Dihydrate Crystal Deposition Disease of the Wrist Joint

Abstract

Introduction. Tumoral calcium pyrophosphate dihydrate (CPPD) crystal deposition disease (CPPDCD), also known as tophaceous calcium pyrophosphate deposition disease (CPDD), is a tumorlike lesion, and it should be distinguished from usual CPDD that causes severe joint inflammation and arthralgia. A case of tumoral CPPDCD of the wrist joint that required differentiation from synovial osteochondromatosis is described. Case Presentation. The patient was a 78-year-old woman with a 5-year history of nodular lesions at the right wrist that had gradually increased in size. An excisional biopsy and a histological examination of the excised nodular lesions by hematoxylin and eosin (H&E) staining were performed, demonstrating numerous polarizable, rhabdoid, and rectangular crystals, surrounded by fibroblasts, macrophages, and foreign body-type giant cells, consistent with tumoral CPPDCD. Conclusion. Tumoral CPPDCD, especially at the wrist joint, is rare, and, to the best of our knowledge, only 2 articles have been published. This case seems to need further follow-up for recurrence, because tumoral CPPDCD may recur after complete or incomplete surgical excision.

An Unusual Pathologic Ulna Fracture Induced by Intraosseous Tumoral Calcium Pyrophosphate Dihydrate Crystal Deposition Disease

“… 9 Often located in the temporomandibular joint or paraspinal tissues, the finding of TCPPDCD in the joints of extremities is rare, with only 3 reported cases occurring at the wrist. 10 , 11 Of the documented cases of TCPPDCD, a predilection for women and patients aged between 31 and 86 years old has been seen. 6 Other risk factors include previous traumas or surgery to the affected joint, osteoarthritis, metabolic conditions (hyperparathyroidism, hypothyroidism, hemochromatosis), and familial CPPDCD.…”

“… 6 Other risk factors include previous traumas or surgery to the affected joint, osteoarthritis, metabolic conditions (hyperparathyroidism, hypothyroidism, hemochromatosis), and familial CPPDCD. 10 , 12) , 13) , 14) …”

An Unusual Case of Huge Tophaceous Pseudogout Mimicking as a Tumor-Like Lesion around the Ankle Joint: A Case Report and Literature Review

“…It manifests as a soft tissue swelling forming a tumor-like mass due to deposition of the CPPD crystals [ 3 ] and can be seen in an intra- or extra-articular location. There have been a number of reports that describe the extra-articular presentation of this condition in certain anatomic locations such as the foot, proximal interphalangeal joint, and wrist [ 3 , 5 , 9 ] in addition to few other reports describing this condition to be intra-articular [ 2 , 6 , 10 ]. We found the mass to be extra-articular lying above the capsule underneath the peroneal tendons in the ankle joint.…”

“…Similarly, tumoral calcinosis also shares a similar location with tumoral CPPD, but it occurs predominantly in younger individuals and is more often multiple. Further, even with the similarity of the presence of hydroxyapatite deposits on histopathology, the definitive differentiating feature is an absence of a crystalline structure [ 5 ]. Chondrosarcoma is a malignant cartilaginous tumor and is seen in older population usually in the fourth to seventh decade and displays a variable calcific pattern [ 3 ], and there are previous reported cases of extraskeletal chondrosarcoma around the ankle joint [ 14 ].…”

Test yourself: a 49-year-old lady with a history of chronic left hip pain following a fall twenty months earlier

“…Factors which predispose to CPPD include older age, genetics, osteoarthritis and the use of certain medications [2]. It can be diagnosed in most cases with a combination of clinical and radiological correlation [3], but rarely presents as an intra-or extra-articular, calcified tumour-like lesion within the joints of the extremities such as the wrist [4] and knee [5]. The temporomandibular joint is the commonest joint involved [6], and the hip is rarely involved.…”