Metastatic pulmonary calcification as a rare complication of end-stage renal disease with coexistence of pulmonary metastases from renal cell carcinoma: case report and literature review

Abstract

PurposeWe present a case of metastatic pulmonary calcification (MCP) in an asymptomatic patient with chronic kidney disease after renal transplantation and nephrectomy due to renal cancer. Chest computed tomography (CT) revealed bilateral, diffuse, centrilobular ground-glass opacities and heterogeneous, high-density areas distributed throughout the lungs, predominantly in the upper and middle lobes. Unusually, in our patient the metastatic calcification coexisted with pulmonary metastases from renal cell carcinoma associated with end-stage renal disease. To our knowledge, such coexistence has not been previously described.Case reportCT, particularly high-resolution chest computed tomography (HRCT), plays an important role in detection and follow-up of MPC findings, which include ground-glass opacities and partially calcified nodules or consolidations, predominantly in the upper lung zones. Correct diagnosis is important because misdiagnosis may lead to improper or unnecessary treatment and/or procedures.ConclusionsMPC is a rare condition that results from calcium deposition in the normal pulmonary parenchyma. MPC commonly occurs in patients with end-stage chronic kidney disease due to abnormalities in calcium and phosphate metabolism. It is worth pointing out that despite the fact that the condition is called metastatic, it is a relatively benign lung disease with a generally good long-term prognosis.

Metastatic Pulmonary Calcification with Coexisting Non-specific Interstitial Pneumonia: A Rare Case Report and Literature Review

“…Recently, co-existence of MPC with renal cell carcinoma (RCC) has been reported [8]. In our patient, MPC was found to co-exist with NSIP, an incidental microscopic finding, diagnosed in a right lower lung lobe wedge biopsy specimen (Figures 3A, 3B).…”

“…It is often an autopsy finding in 60%-70% of patients with underlying renal failure [7]. MPC has also been reported in a variety of other benign conditions such as primary and secondary hyperparathyroidism, intravenous calcium therapy, osteoporosis, sarcoidosis, milk-alkali syndrome, Paget’s disease as well as with malignant conditions including parathyroid carcinoma, lymphoma, breast carcinoma, choriocarcinoma, malignant melanoma, synovial carcinoma, hypopharyngeal squamous cell carcinoma, massive osteolysis from metastases and multiple myeloma [8]. The metastatic calcium depositions are caused by the release of excess calcium salts from bone and their transport through the circulatory system to the organs.…”

Metastatic microcalcification in the lungs and stomach due to hyperparathyroidism: A case report

“…Most reports of metastatic microcalcification have involved patients with end-stage chronic renal disease but occasionally the entity has been reported in patients with osteolytic malignancies, sarcoidosis, hypervitaminosis D and PHPT. 10 – 15 Data from the few reports of metastatic microcalcification due to parathyroid adenoma have shown that the deposition tends to occur in the stomach, kidneys, heart and lungs, with the pulmonary system being particularly susceptible. 4 – 7 , 16 The pathogenic mechanisms of metastatic microcalcification have yet to be elucidated but most reports suggest that hypercalcaemia and a local alkaline environment may contribute to the condition.…”