Idiopathic calcinosis of the scrotum: Histopathologic observations of fifty-one nodules

Idiopathic scrotal calcinosis (ISC) is a rare benign condition which presents with multiple, asymptomatic, and painless nodules on the scrotal skin wall. The lesions have been attributed as sebaceous cysts, calcified steatocystoma, fibroma, atheroma, and xanthoma. Shapiro et al. reviewed the histologic data and found no evidence of an epithelial lining, residual cysts, and lipid or organisms, and concluded that the calcification was idiopathic introducing the term "idiopathic scrotal calcinosis." We have studied four cases of idiopathic scrotal calcinosis, one of which had scrotal calcinosis involving the whole of the scrotum. He presented with painless multiple nodules over the scrotum. He was subjected for surgery with SOS skin grafting, but as the scrotal skin is so lax, primary closure is easily possible. In all our four cases, primary closure was easily possible. Keywords Calcinosis . Inclusion cyst . Scrotal swellings Case HistoryA 40-year-old male came in surgery OPD for multiple painless nodules involving the whole of the scrotum (Fig. 1). All routine investigations including HIV and VDRL were done which were normal. He was posted for in toto excision with skin grafting, but surprisingly, primary closure was possible and his postoperative recovery was very good (Fig. 2). The specimen was sent for histopathology which was suggestive of calcinosis of the scrotum (Fig. 3).

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“…Others support the theory of epidermal inclusion cyst playing a major role in the pathogenesis of the disease [3].…”

Section: Discussionmentioning

confidence: 97%

Idiopathic Scrotal Calcinosis

2016

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“…12 Histologically, ISC is characterized by calcium depositions of various sizes that are surrounded by a granulomatous reaction. 13 Despite the controversy about the origin of this entity, surgery still seems to be the treatment of choice and provides a good clinical outcome. The laxity of the scrotal skin, along with the decision to perform multiple elliptical excisions, allowed for good scrotal coverage and excellent cosmetic outcome.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic scrotal calcinosis: A rare entity and a review of the literature

Pompeo

Molina

Pohlman

et al. 2013

CUAJ

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Scrotal calcinosis is a rare condition with presentation including intradermal nodules varying in size and number. Differentials include calcification of epidermal or pilar cysts noted by the presence of keratinaceous debris. We present 2 cases of scrotal calcinosis at our institution. IntroductionIdiopathic scrotal calcinosis (ISC) was first described in 1883 by Lewinski. 1 The clinical presentation of ISC includes gradual growth of brown-yellow, firm solitary or multiple nodules on the scrotal skin. This rare, benign condition of uncertain etiology typically begins in adolescence or early adulthood and occurs in the absence of abnormalities in calcium and phosphate metabolism. 2 The intradermal nodules tend to increase in size and number over time and can produce a white, chalky material. While these lesions are usually asymptomatic, some patients report pain and itching and there have also been reports of infection associated with ISC. Indications for surgery include relief of symptoms and preservation of scrotal cosmesis. The only treatment recommended for ISC is surgery, which allows for pathologic confirmation of the disorder. 3 We present 2 cases of this rare pathology treated surgically, as well as review of the current literature. Case 1A 22-year-old male was referred to the urology clinic with a 2-year history of asymptomatic scrotal nodules that had gradually increased in size and number. He denied history of scrotal trauma; he also had no history of any metabolic, systemic, neoplastic or autoimmune disease. The increasing number and size of the nodules were affecting his quality of life. He reports that he has avoided intimate relationships because he is embarrassed of his scrotal lesions. He also described increased itching secondary to the lesions. On physical examination, the patient was healthy and in no acute distress. The only significant findings on exam were multiple palpable dark yellow and brown subcutaneous nodules on the scrotum with no pain on palpation. The calcified nodules involved most of the entire scrotum (Fig. 1). His clinical findings were consistent with the working diagnosis of ISC. These lesions were confined to the scrotum with no other skin lesions elsewhere. His testes were palpably normal. Laboratory evaluation revealed a normal serum calcium, phosphorus and parathyroid hormones level.The patient was taken to the operating room where general anesthesia was administered. The involved scrotal skin was excised using multiple elliptical incisions to preserve some uninvolved skin to allow for adequate coverage for skin closure. The scrotal skin excised did not involve the dartos fascia. Several smaller calcifications were also excised individually. All of the defects were closed using 4-0 chromic suture in an interrupted fashion. The patient has not experienced any postoperative complications to date and he has fortunately had a good scrotal cosmetic outcome (Fig. 2). Pathologic analysis revealed extensive large and small dermal calcium deposits with fibrosis, epiderm...

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“…Most authors have documented that epithelial cysts themselves calcify and turn into calcified nodules (15,16,17,18). In a study of Shah et al (15) with 20 SC cases; 14 patients revealed epidermal cysts with a variable amount of keratin and calcification in the vicinity of scrotal nodules, and 6 revealed nodules with abundant calcification and remnant epithelial structures in them.…”

Section: Discussionmentioning

confidence: 99%

“…Finally with progressive calcification, total disappearance of the epithelial structures occur and large residual areas of calcification left behind with the classic picture of SC. With the composition of the findings Song et al (18) implied that the keratin content might be more resistant to inflammation than the attenuated cell wall. In this way after the rupture of cysts, the resorption of the wall is rapid and calcified keratinous material surrounded by inflammatory cells may be seen even when the cyst wall could not be observed anymore.…”

Section: Discussionmentioning

confidence: 99%