Gastric Mucosal Calcinosis

Abstract

Generally, gastric mucosal calcinosis (GMC) is only rarely encountered in routine biopsies. GMC may be classified as dystrophic, metastatic, or idiopathic. Metastatic calcification represents the most frequently encountered subtype, and refers to the deposition of calcium salts on largely normal tissues in the setting of an abnormal serum biochemical environment (hypercalcemia, hyperphosphatemia, and/or an elevated Ca  PO4 product). In contrast, dystrophic calcification implies calcification in inflammed, fibrotic, or otherwise altered tissue in the setting of a normal biochemical environment. The gastric mucosa, along with the kidneys and lungs, are preferential sites for metastatic calcification, a finding that has been attributed to the relative intracellular alkalinity at these sites. In addition to the wide variety of hypercalcemia and/or hyperphosphatemiacausing clinical conditions, GMC has also been associated with atrophic gastritis, hypervitaminosis A, organ transplantation, gastric neoplasia, uremia with eucalcemia/euphosphatemia, and the use of aluminum-containing antacids, citrate-containing blood products, isotretinoin, and sucralfate. Although GMC has rarely been associated with epigastric pain and/or dyspepsia, most come to clinical attention owing to their accumulation of bone-seeking radiopharmaceuticals or represent a postmortem finding. The precise significance or mechanistic basis for GMC remains to be elucidated. However, their presence in gastric biopsies should be reported, as they may serve as an indicator for generalized metastatic calcification, especially in organs where they may be fatal, such as the heart. Furthermore, some examples of systemic calcification are reversible with normalization of biochemical parameters, which highlights the need for pathologists to report this finding when encountered in a premortem gastric biopsy.

Calcium orthophosphates

“…One author has mentioned “apatite diseases,” which are characterized by the appearance of needle-like crystals comparable to those of bone apatite in the fibrous connective tissue 800 . All these cases are examples of calcinosis, 801 - 803 which might be described as a formation of calcium orthophosphate deposits in any soft tissue. In dentistry, a calculus or a tartar refers to a hardened plaque on the teeth formed by the presence of saliva, debris and minerals 804 .…”

Metastatic Calcinosis of Gastric Mucosa

“…Based on the etiology of calcium deposition, calcification is classified into 4 subtypes: dystrophic, metastatic, iatrogenic, and idiopathic. 1 Dystrophic calcification results from local tissue damage and deposition of salts in inflamed, and fibrotic tissue in the setting of normal calcium metabolism. In iatrogenic calcinosis, calcium salts are deposited as a result of therapeutic interventions for other diseases.…”

“…Idiopathic calcification occurs with no identifiable cause, where calcifications occur in normal tissue with normal serum markers. 1 - 4 Various causes of calcification and their pathophysiology are described in Table 1 . Our patient demonstrated metastatic calcinosis cutis, which is a diagnosis of exclusion and laboratory studies should be analyzed to rule out other diseases.…”

Extraosseous Calcification of the Esophagus: Clinicopathologic Correlates of Esophageal Mucosal Calcinosis

“… 1 Calcification of visceral and soft tissue is classified into 4 distinct categories based on causality: dystrophic, iatrogenic, metastatic, and idiopathic. 2 Dystrophic calcification refers to calcium salt deposition in fibrotic or inflamed tissue in the absence of hypercalcemia or hyperphosphatemia. Iatrogenic calcification occurs as a direct result of a pharmacologic or therapeutic intervention (eg, calcium supplementation).…”