Understanding calcinosis cutis

SaterenZoller, Elizabeth; Rizzo, Marco; Harris, Albert R.

doi:10.1097/01.jaa.0000718276.11292.e2

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Calciphylaxis is associated with a particularly grim prognosis [1]. A list of diagnoses and pathologic processes associated with these CC subtypes is detailed elsewhere (Table 1) [1,2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Though our patient did not have autoimmune titers or recent serum calcium or phosphate levels, he also did not have clinical findings which would suggest a CTD or other systemic process.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic calcinosis cutis with unusual histomorphology and negative von Kossa stain: A diagnostic pitfall

Irwin

Hamza

George

et al. 2023

J Case Rep Images Pathol

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Introduction: Calcinosis cutis is characterized by basophilic crystalline or amorphous calcium within the dermis/subcutis. Calcinosis cutis has many different clinical subtypes and associated etiologies that may lead clinicians to consider this diagnosis. Von Kossa and/or Alizarin red special stains may be used by pathologists to highlight deposition of insoluble calcium salts, especially in histologically ambiguous or subtle cases. Case Report: We report the case of a 27-year-old male who presented with an inferior right buttock mass clinically diagnosed as epidermal inclusion cyst(s). Gross pathology revealed a gray-white pasty substance within a cyst-like structure. Histopathologic examination demonstrated pools of amorphous blue-gray material with rare deposits of admixed coarse calcifications surrounded by foreign-body giant cells. No cyst wall was seen in the specimen. Special stains, including von Kossa, were initially negative. Following additional review, it was discovered that surface decalcifying solution had been applied to the paraffin block in the histology lab prior to microtome sectioning. Hypothesizing that this could be the cause of the unusual morphology, the paraffin block was reprocessed and subsequent H and E stained sections displayed characteristic basophilic calcium deposits, which were correspondingly positive by von Kossa stain. Conclusion: The histopathologic diagnosis of calcinosis cutis is apparent by HandE in most cases, though von Kossa and/or Alizarin red special stains can be used to aid the pathologist. Given the unusual histomorphology following surface decalcification and initial lack of von Kossa stain prior to reprocessing, this report serves to make pathologists aware of this potential diagnostic pitfall.

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Section: Discussionmentioning

confidence: 99%

Idiopathic calcinosis cutis with unusual histomorphology and negative von Kossa stain: A diagnostic pitfall

Irwin

Hamza

George

et al. 2023

J Case Rep Images Pathol

View full text Add to dashboard Cite

show abstract

“…Meanwhile, a pelvic CT scan showed extensive subcutaneous calcinosis in both hips ( Figure 1 ). [ 1 , 2 ] His shortness of breath gradually improved after being treated with tofacitinib 5 mg twice a day [ 3 ] and intravenous cyclophosphamide 400 mg every 2 weeks, and his prednisone was tapered.…”

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confidence: 99%

Subcutaneous calcinosis in a patient with anti-MDA5 positive dermatomyositis

Hou

Zhang

et al. 2021

Rheumatology and Immunology Research

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Dystrophic calciphylaxis in panniculitis: features of the clinical picture and diagnosis

Egorova,

Datsina,

Severinova

2023

Sovremennaâ revmatologiâ

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The clinical presentation of lobular panniculitis (PN) associated with calciphylaxis (CP, calcification) can vary widely and may be associated with joint and internal organs involvement, making the diagnosis of the disease difficult.Objective: to evaluate the frequency and significance of CP in patients with PN using long-term prospective follow-up.Material and methods. From 2018 to 2023, at the V.A. Nasonova Research Institute of Rheumatology 217 patients with referral diagnosis "erythema nodosum" or "panniculitis" were examined. In 19.3% of cases (9 men and 33 women aged 37 to 72 years) CP was confirmed with an average disease duration of 56.3±11.2 months. Clinical examination of patients was performed according to the standards recommended by the Russian Association of Rheumatologists. International criteria were used to confirm the diagnosis of systemic lupus erythematosus (SLE), idiopathic inflammatory myopathies (IIM), systemic sclerosis (SS), and lipodermatosclerosis (LDS). In 12 patients with indurations, pathological examination of biopsy specimens of skin and subcutaneous fatty tissue from the area of induration was performed, which allowed confirming the diagnosis of idiopathic lobular PN (ILPN) in 3 cases. Four grades of calcification were distinguished according to the size and depth of the calcifications. In addition, considering the type of radiological changes and clinical manifestations, four subtypes of CP were identified: mousse-like, stone-like, mesh-like and lamellar-like.Results and discussion. In the study group, the ratio of women to men was 3.6:1, and the mean age was 43.8±7.6 years. On clinical examination we determined, in 60% of cases CP predominantly stone-like subtype (71.4%) of first grade (47.6%), which was significantly more frequently located on the upper and/or lower extremities and/or trunk (57.1%; p=0.05). Using clinical, laboratory and instrumental data, we confirmed the development of CP in ILPN (n=3), SLE (n=3), LDS (n=21), IIM (n=5), SS (n=1), and idiopathic CP (n=9) with a mean disease duration of 8.7±2.4 years.An increase in ESR and CRP levels occurred in different diseases, while urinary syndrome was associated with SLE (66.6%) and an increase in creatinine phosphokinase with IIM. Decreased calcium and 25-hydroxyvitamin D levels and increased phosphorus and parathyroid hormone levels were found in many patients studied.Conclusion. In the absence of clear diagnostic criteria for CP in patients with PN, early diagnosis is critical for the development of an effective multidisciplinary treatment plan.

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Understanding calcinosis cutis

Cited by 3 publications

References 9 publications

Idiopathic calcinosis cutis with unusual histomorphology and negative von Kossa stain: A diagnostic pitfall

Idiopathic calcinosis cutis with unusual histomorphology and negative von Kossa stain: A diagnostic pitfall

Subcutaneous calcinosis in a patient with anti-MDA5 positive dermatomyositis

Dystrophic calciphylaxis in panniculitis: features of the clinical picture and diagnosis

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