Tumoral Calcinosis Form of Hydroxyapatite Deposition Disease in Related Red-Bellied Short-Necked Turtles, Emydura subglobosa

Abstract

Ten of 12 red-bellied short-necked turtles from a single clutch presented at 9 months of age with multiple white to tan nodules on their feet. Histologically, the nodules were composed of large periarticular deposits of mineralized crystalline material that extended into the joint spaces of interphalangeal joints and was surrounded by granulomatous inflammation and fibrosis. Crystallographic analysis determined the material to be apatite (calcium phosphate hydroxide) consistent with the tumoral calcinosis form of hydroxyapatite deposition disease (HADD). HADD has previously been described in aquatic turtles and rarely lizards and must be differentiated from gout in reptiles. A cause for the tumoral calcinosis lesions in these turtles could not be determined; however, based on previous reports in this species, a species-specific predilection, in conjunction with unknown environmental factors, is suspected. The use of the terms HADD, pseudogout (calcium pyrophosphate crystal deposition disease), and calcinosis circumscripta has been inconsistent, creating confusion in the literature.

Calcium orthophosphates (CaPO4): occurrence and properties

“…According to the data available (Poloni and Ward 2014 ), the unwanted depositions could consist of many substances and all of them always lead to various diseases. Regarding the unwanted depositions of CaPO 4 , they are found in soft tissue calcification (in damaged joints, blood vessels, dysfunctional areas in the brain, diseased organs, scleroderma, prostate stones) (Reid and Andersen 1993 ; Scotchford and Ali 1995 ; P’ng et al 2008 ; Brancaccio and Cozzolino 2005 ; Goff and Reichard 2006 ; Bittmann et al 2003 ; Molloy and McCarthy 2006 ; Giachelli 2004 ; Kazama et al 2007 ), kidney (Giannossi and Summa 2012 ; Mukherjee 2014 ) and urinary (Zhu et al 2014 ; Huo et al 2015 ; Selvaraju et al 2015 ) stones, dental pulp stones and dental calculus (Kakei et al 2009 ; Kodaka et al 1988 , 1998 ; Çiftçioglu et al 1998 ; Hayashizaki et al 2008 ), salivary stones (Zelentsov et al 2001 ; Luers et al 2014 ), gall stones (Qiao et al 2013 ; Hussain and Al-Jashamy 2013 ), pineal gland calcifications (Güney et al 2013 ), atherosclerotic arteries and veins (Ortlepp et al 2004 ; Tomazic 2001 ; Marra et al 2006 ; Kurabayashi 2013 ), coronary calcification (Fitzpatrick et al 2003 ; Matsui et al 2015 ), damaged cardiac valves (Suvorova and Buffat 2005 ), calcification on artificial heart valves (Giachelli 2001 ; Pettenazzo et al 2001 ; Schoen and Levy 2005 ; Delogne et al 2007 ), carpal tunnel (Sensui et al 2003 ; Namba et al 2008 ) and tumoral (Namba et al 2008 ; Carlson et al 2007 ; Sprecher 2010 ; Slavin et al 2012 ; Kim et al 2013 ; Burns et al 2013 ) calcifications, cataracts (Kim and Choi 2007 ; Koinzer et al 2009 ), malacoplakia (Ho 1989 ), calcified menisci (Katsamenis et al 2...…”

Calcium orthophosphates (CaPO 4 ): Occurrence and properties

“…One author has mentioned on ''apatite diseases'' which are characterized by the appearance of needle-like crystals comparable to those of bone apatite in the fibrous connective tissue (Mohr 2003). All these cases are examples of a calcinosis (Sprecher 2010;Slavin et al 2012;Kim et al 2013;Burns et al 2013), which might be described as a formation of undesired CaPO 4 deposits in any soft tissue. In dentistry, a calculus or a tartar refers to a hardened plaque on the teeth, formed by the presence of saliva, debris and minerals (White 1997).…”

“…in addition to or in place of biological apatite (Table 5; LeGeros 1991LeGeros , 2001Amjad 1997;Daculsi et al 1997;Qiu and Orme 2008;Kodaka et al 1988;Reid and Andersen 1993;Scotchford and Ali 1995;P'ng et al 2008;Bazin et al 2014b;Lee et al 2006;Rosenthal 2007;Lagier and Baud 2003;Wesson and Ward 2007). However, precipitation of biological apatite in wrong places is also possible; this is the so-called ''HA deposition disease'' (Burns et al 2013;Hayes and Conway 1990;Best et al 1997;Garcia et al 2003;Melrose et al 2009). …”

Calcinosis circumscripta in a dog

“…Calcinosis circumscripta is an uncommon tumor like lesions characterizated solid or multiple masses by ectopic, dystrophic, metastatic and iatrogenic deposition of calcium salts in soft tissues (2,(8)(9)(10)(11). The pathogenesis of this lesions are unknown, but dog may develop suffering from serious illness such as chronic renal disease (11).…”

“…Metastatic calcinosis is mostly seen in human beings while the other types is usually encountered in dogs and cats (1,3,9,10). Metastatic calcinosis is frequently occured in calcium-phosphate metabolic disorders such as hypercalcemia, hyperphospahatemia and chronic renal disorders (2,4,5,8,10). However, distrophic calcinosis is followed to necrosis, inflammation and neoplasia inspite of beings normally calciumphosphat levels in blood.…”