Imaging of tumoral calcinosis: new observations.

Abstract

Five patients with tumoral calcinosis were evaluated with radiography, bone scintigraphy, computed tomography (CT), and magnetic resonance (MR) imaging. The arthropathy of calcium pyrophosphate dihydrate deposition disease was seen in two of the patients and pseudoxanthoma elasticum-like syndrome in three. Identification of calcific particular masses on radiographs is characteristic of tumoral calcinosis. Marrow lesions could be identified as patchy areas of calcification (calcific myelitis) in long bones and the calvarium. Bone scintigraphy appears to be the best modality for detection of the masses and marrow lesions and for monitoring therapy. At CT the masses demonstrated a varied appearance, from small and solid to large and cystic. The marrow abnormality appears as an area of increased attenuation and spotty calcification that in the skull may be associated with dural and vascular calcifications. MR imaging of the particular masses was remarkable in that the masses displayed high signal intensity on T2-weighted images despite a large calcific component. Marrow lesions also showed increased signal intensity on T2-weighted images. When calcified particular masses are present the diagnosis is rarely in question. The diagnosis may be overlooked, however, when calcific myelitis is the only manifestation.

Tumoral Calcinosis in the Upper Cervical Spine Causing Progressive Radiculomyelopathy. Case Report.

“…3) One third of tumoral calcinosis cases are familial with a 50% penetrance, suggesting an autosomal-recessive trait. 9) Hereditary abnormality of phosphorus metabolism, recurrent soft-tissue microtrauma, renal failure, and secondary hyperparathyroidism may all be involved in the pathogenesis of tumoral calcinosis. Reduced renal tubular transport of phosphorus and increased renal tubular reabsorption of phosphorus may be factors leading to hyperphosphatemia.…”

Tumoral Calcinosis: A Case Report

“…1 It is painless and asymptomatic and usually presents as a calcified soft-tissue mass around a large joint (usually extensor aspect) that affects the bursa and may cause pressure symptoms (e.g. nerve root compression).…”

“…Bone marrow lesions (usually in children) are a definite component of tumoral calcinosis and usually affect long bones (occasionally the skull) and resolve spontaneously. 1 They show patchy sclerosis of the medullary canal. Other associated lesions include calcific deposits of dental pulp with obliteration of the cavity (pulp stones) with bulbous and short roots (Fig.…”

Tumoral Calcinosis

“…Films exposed with a horizontal beam may show the "sedimentation sign" due to mineral portion pooling dependently, creating a fluid calcium level [6]. Symmetrical and bilateral involvement is seen commonly.…”

“…Bone scintigraphy with radio labelled phosphate compounds (Technetium 99m methylene diphosphonate), demonstrates increased uptake in the soft-tissue masses. On magnetic resonance imaging (MRI), the lesion is hypointense on all sequences with presence of areas of high signal on T2 and inversion recovery sequences, corresponding to oedema due to an inflammatory response to pathologic calcification [6]. The lesions are cystic and multilocular with a capsule and prominent fibrous septae on gross pathology.…”