Hyperphosphatemic tumoral calcinosis

Mallick, Saumyaranjan; Ahmad, Zohra; Gupta, Arun Kumar; Mathur, Sandeep

doi:10.1136/bcr-2013-008728

Cited by 7 publications

(10 citation statements)

References 12 publications

(10 reference statements)

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“…Proposed mechanisms include inborn errors of metabolism, abnormal transfer of phosphorous, and a genetic predisposition. However, the reasons behind it remains unclear 2 5 17. It is known that there is a familial tendency with a predominance of African descent without sex predominance 2.…”

Section: Discussionmentioning

confidence: 99%

“…Myositis ossificans can be distinguished by its rapid evolution and lack of lobular morphology. Calcific myonecrosis occurs most often following ischaemic necrosis of muscle, typically the result of a compartment syndrome in an extremity 1 5. Synovial chondromatosis is usually intra-articular and shows rings-and-arcs morphology of the calcifications 5…”

Section: Differential Diagnosismentioning

confidence: 99%

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Sedimentation sign: a classical finding on tumorous calcinosis

et al. 2022

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The authors describe the case of a man in his 60s who presented with progressive pain and swelling of the right hip. Imaging features showed a densely calcified lesion associated with ‘sedimentation sign’. Laboratory tests revealed slight hyperphosphataemia. Surgical excision of the lesion was performed. Histological examination revealed chalky material surrounded by fibrosis and giant multinucleated cells, compatible with tumorous calcinosis. Patient made a full recovery. We report a rare case of tumorous calcinosis and compare this condition with its common mimics.

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Section: Discussionmentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

Sedimentation sign: a classical finding on tumorous calcinosis

et al. 2022

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“…Symptomatic treatment for very painful skin lesions with fine needle aspiration and percutaneous fragmentation reported pain relief by 30% [12]. Therapy for metabolic calcification should seek control of the underlying hormonal or metabolic cause [13]. Intravenous sodium thiosulfate (STS) may be an effective option for treating calcifications in patients undergoing hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

“…The recurrence of these lesions can occur, and therefore it is necessary to clearly establish the etiology of the lesions, to offer a correct treatment. Although metabolic control should be the objective, the option of local treatments, combined therapies or surgical removal are options for painful lesions [13].…”

Section: Discussionmentioning

confidence: 99%

Isolated Tumoral Calcinosis in the Hip Mimicking Peri-articular Infection: A Case Report and Literature Review

Mr¹,

Salinas-Alvarez²,

Lc³

et al. 2019

Rheumatology

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Introduction: Tumoral calcinosis is a rarely described metabolic condition, characterized by the accumulation of calcium hydroxyapatite crystals in the soft tissues. The purpose of this paper is to present a case of a tumoral calcinosis with uncommon characteristics in order to discuss the diagnosis and treatment options. Case report: We report the case of a 65 years-old patient with a multifactorial avascular necrosis of the femoral head, to which a hip replacement was planned. Due to the images observed preoperatively, infection was ruled out and after the studies; an isolated tumoral calcinosis was identified and confirmed with histopathological findings. Conclusion: Tumoral calcinosis is a benign pathology that can create confusion due to the nonspecific characteristics. Metabolic profile studies and multimodal imaging are recommended to diagnose this condition adequately. In some cases, biopsy or aspiration can also be helpful to confirm the diagnosis.

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“…It adds to the very limited literature on the ultrasound appearance of HADD in small joints. It also emphasizes the role of DECT, when routine crystal analysis is uninformative, in detecting hydroxyapatite deposition .…”

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confidence: 99%

Polyarthritis as a Rare Presentation of Hydroxyapatite Deposition Disease

Aslam

Matteson

2016

Arthritis & Rheumatology

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The patient, a 78-year-old woman, presented with a 4-year history of inflammatory, seronegative polyarthritis of the hands, wrists, knees, and feet. Joint aspiration showed inflammation but did not reveal crystals or microorganisms. Treatment using multiple immunomodulating agents failed to fully control the synovitis; only prednisone was partially effective. Dorsal longitudinal (left) and transverse (not shown) ultrasound of the involved proximal interphalangeal (PIP) joint revealed an effusion (thin arrow) surrounded by a hyperechoic calcified rim (thick arrow). Unlike gout or calcium pyrophosphate deposition disease, the hyperechoic material was not within or on the cartilage. Synovitis and erosion, typical symptoms of rheumatoid arthritis, were absent on the ultrasound. Toothpaste-like material was aspirated from a PIP joint; no crystals were identified. A dual-energy computed tomography (DECT) scan of the patient's hands revealed degeneration and extensive bilateral, periarticular, circumferential, lobulated mineralization around several joints; this included PIP joints 2-4 of the right hand, color-coded as purple, in a volume-rendered, 3-dimensional image (right) (arrow). Monosodium urate pixelation was absent; however, intraosseous extension was noted. Some deposits demonstrated layered calcium levels (which can be a sediment sign). Spectroscopy of the joint aspirate revealed calcium phosphate (apatite [90%] and calcium carbonate [10%]). Polarized microscopy revealed a calcium carbonate crystal among amorphous calcium deposition. Extensive evaluations for metabolic, malignant, and infectious disease were uninformative. Calcific periarthritis is the most common form of hydroxyapatite deposition disease (HADD). Tumoral calcinosis is visible around large joints and extensor surfaces, mostly as a familial form or in phosphorus metabolism disorders. The occurrence of lesions primarily in small joints is rare and produces diagnostic confusion, especially with pseudogout and gout (1). Erosive polyarticular disease is a very rare feature of HADD (2). This case represents a most unusual presentation, which included extensive joint involvement, that mimicked rheumatoid arthritis. It adds to the very limited literature on the ultrasound appearance of HADD in small joints. It also emphasizes the role of DECT, when routine crystal analysis is uninformative, in detecting hydroxyapatite deposition (3).

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Hyperphosphatemic tumoral calcinosis

Cited by 7 publications

References 12 publications

Sedimentation sign: a classical finding on tumorous calcinosis

Sedimentation sign: a classical finding on tumorous calcinosis

Isolated Tumoral Calcinosis in the Hip Mimicking Peri-articular Infection: A Case Report and Literature Review

Polyarthritis as a Rare Presentation of Hydroxyapatite Deposition Disease

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