Tophaceous pseudogout of the temporomandibular joint with erosion into the middle cranial fossa

Houghton, David; Munir, Nazia; Triantafyllou, Asterios; Begley, Anne

doi:10.1016/j.ijom.2020.03.011

Cited by 9 publications

(7 citation statements)

References 8 publications

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“…Tophaceous pseudogout is a mass-forming deposition of calcium pyrophosphate dehydrate (CPPD) crystals, described in the temporomandibular joint and other locations, including extremities, 11,20,21 which features a giant cell reaction, and in a subset, secondary chondroid metaplasia which can be extensive. CPPD is associated with several clinical manifestations, and many patients are asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

Calcified Chondroid Mesenchymal Neoplasm

Kallen

Meyer

Suster

et al. 2023

American Journal of Surgical Pathology

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Calcified chondroid mesenchymal neoplasm is a term proposed for tumors with a spectrum of morphologic features, including cartilage/chondroid matrix formation, that frequently harbor FN1 gene fusions. We report a series of 33 cases of putative calcified chondroid mesenchymal neoplasms, mostly referred for expert consultation out of concern for malignancy. Patients included 17 males and 16 females, with a mean age of 51.3 years. Anatomic locations include the hands and fingers, feet and toes, head and neck, and temporomandibular joint; 1 patient presented with multifocal disease. Radiologic review showed soft tissue masses with variable internal calcification, which occasionally scalloped bone but in all cases appeared indolent/benign. Tumors had a mean gross size of 2.1 cm and a homogenous rubbery to fibrous/gritty tan-white cut surface. Histology demonstrated multinodular architecture with a prominent chondroid matrix and increased cellularity towards the periphery of the nodules. The tumor cells were polygonal with eccentric nuclei and bland cytologic features and showed a variable amount of increased spindled / fibroblastic forms in the perinodular septa. The majority of cases had notable grungy and/or lacy calcifications. A subset of cases demonstrated at least focal areas of increased cellularity and osteoclast-like giant cells. Herein, we confirm the distinct morphologic and clinicopathologic features associated with this entity with the largest series to date, with a focus on practical diagnostic separation from similar chondroid neoplasms. Awareness of these features is critical in avoiding pitfalls, including a malignant diagnosis of chondrosarcoma.

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Section: Discussionmentioning

confidence: 99%

Calcified Chondroid Mesenchymal Neoplasm

Kallen

Meyer

Suster

et al. 2023

American Journal of Surgical Pathology

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“… 5 Pseudogout of the TMJ has been reported more often in the literature, with seven cases involving erosion into the skull base. 6 Gout of the TMJ presents clinically in a similar way to pseudogout, but the difference is the aetiology and long-term treatment. The treatment for gout of the TMJ involves urate lowering medication as first-line management, and surgery if the patient continues to be symptomatic or has reduced jaw function.…”

Section: Discussionmentioning

confidence: 99%

Gout of the temporomandibular joint and review of the literature

2023

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Gout is a disease characterised by abnormal deposition of monosodium urate crystals, typically affecting the extremities. This report describes a rare case of gout affecting the left temporomandibular joint with erosion of the skull base. A diagnosis of gout was suspected based on computed tomography and magnetic resonance imaging and confirmed with computed tomography guided biopsy. The temporomandibular joint is an uncommon location for a first presentation of gout, with very few cases documented and only three cases of skull base involvement reported in the English literature previously. Given its radiological appearance, it can easily be misdiagnosed as other erosive arthropathies or malignancy. Our paper highlights an unusual location for the first and only manifestation of gout and offers some diagnostic and treatment ideas that may help clinicians to identify and manage this disease.

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“…Pseudogout was pre-operatively diagnosed in 8 of the 10 patients. The remaining two patients were diagnosed with a neoplastic lesion or synovial osteochondromatosis [ 5 ] and synovial chondromatosis [ 7 ], respectively. General treatment of pseudogout is supportive to minimize symptoms [ 1 ]; however, tophaceous pseudogout that destroys surrounding structures sometimes requires surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebrospinal fluid leakage occurred as an intra-operative complication in one patient [ 8 ]. Exposure of the dura mater was overlaid using a flap of temporal muscle [ 2 , 5 , 9 ], temporalis fascia [ 7 ], harvested fat [ 2 ] and bone wax [ 8 ]. No patients developed brain damage as a post-operative complication.…”

Section: Discussionmentioning

confidence: 99%

Tophaceous pseudogout of the temporomandibular joint extending into the cranium: a case report with literature review

Takeda

Miyamoto

Abe

et al. 2022

Journal of Surgical Case Reports

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Pseudogout is a disease characterized by calcium pyrophosphate crystal deposition. Involvement of the temporomandibular joint (TMJ) is rare. We herein report a case of tophaceous pseudogout of the TMJ with cranial extension. An 83-year-old woman was referred to our institution for treatment of right TMJ pain. The patient’s medical and family histories were unremarkable. Magnetic resonance imaging showed a mass of about 35 mm in diameter compressing the bottom of the right temporal lobe of the brain. Based on a clinical diagnosis of a right TMJ tumour, biopsy was performed under general anaesthesia. The histopathological diagnosis was pseudogout. Considering the risk of surgically induced brain damage, the patient’s advanced age and her relatively good quality of life, the treatment plan simply involved the observation of the lesion. Fourteen months after biopsy, the patient’s activities of daily living remained unchanged and she had no TMJ pain.

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Tophaceous pseudogout of the temporomandibular joint with erosion into the middle cranial fossa

Cited by 9 publications

References 8 publications

Calcified Chondroid Mesenchymal Neoplasm

Calcified Chondroid Mesenchymal Neoplasm

Gout of the temporomandibular joint and review of the literature

Tophaceous pseudogout of the temporomandibular joint extending into the cranium: a case report with literature review

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