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MUSCULOSKELETAL IMAGING Table of Contents   
Year : 2004  |  Volume : 14  |  Issue : 3  |  Page : 245-246
Tumoral calcinosis - a case report


Department of Radiology, Gauhati Medical College, Guwahati-781032, India

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Keywords: Tumoral Calcinosis, Juxta articular

How to cite this article:
Hazarika K, Borborah T R, Choudhury H R, Sharma M. Tumoral calcinosis - a case report. Indian J Radiol Imaging 2004;14:245-6

How to cite this URL:
Hazarika K, Borborah T R, Choudhury H R, Sharma M. Tumoral calcinosis - a case report. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Nov 16];14:245-6. Available from: http://www.ijri.org/text.asp?2004/14/3/245/28594

   Introduction Top


Tumoral calcinosis is not a tumor in the neoplastic sense but is an encapsulated, saccular, multi-loculated calcific collection adjacent to a joint or bony prominence. This is a relatively uncommon disorder and its radiological diagnosis is vital for management. Here we present a case of tumoral calcinosis with typical radiographic features.


   Case Report Top


A 14 year old girl presented with a large swelling in the right lateral aspect of the thigh and a small lobulated swelling in the lateral aspect of left foot adjacent to the 5 th toe. The thigh swelling had appeared 1 '/2 years back immediately followed by the foot lesion. The swellings enlarged slowly attaining a large size in the thigh. History of ulceration with exudation of whitish material was also elucidated.

On examination, the swellings were non-tender, lobulated, and firmly attached to underlying muscle. A healed ulcer pit was seen in the foot swelling.

Radiographs revealed densely lobulated homogenous calcific masses with fluid-fluid levels, lying in the lateral aspect of the right hip and lateral aspect of 5th metatarsal left foot. Adjacent bones had normal density and were intact. The lobulated calcific masses showed intervening lucent septae giving a multi-loculated appearance.

Ultrasound revealed multi-loculated cystic lesions with densely echogenic debris showing layering in the dependent regions and movement with positional changes.

Serum calcium level was found to be normal, while the serum inorganic phosphate level was 6.5 mg / dl. ESR was raised to 60 mm AEFH.

Pathological examination of ultrasound-guided aspirated material showed multiple refractile crystalloids natural brown to black in color and occasional macrophages / multi-nucleated giant cells.


   Discussion Top


Also termed as lipocalcinogranulomatosis, calcifying endothelioma and calcareous granuloma, these are painless calcified masses in juxta-articular regions. Common sites are hips (near trochanter and buttocks), elbow, toes, wrists, ankles, shoulders, ribs, ischial spines and rarely, in the knees. It is usually seen in children, manifesting mostly in the 2nd decade [1]. The masses usually grow progressively; attain large sizes, 1 . 20cm, are largest around the hips and smallest around the toes, Sometimes the masses show surface ulceration and exude chalky, semi-liquid material containing calcium. Bones remain intact unless large juxta-articular masses cause restriction of joint functions or pressure bone erosion. It remains painless unless nerve compression occurs [2].

Familial tendency with an autosomal recessive inheritance has been suggested although evidence suggests that an autosomal dominant mode with varying penetrance also exists [3]. Majority of the cases have an inborn error of phostphate metabolism [3]. Hyperphosphatemia with normal GFR characterized by high ratio of phosphorous tubule maximum (TmP) to GFR [4]. Fluid-fluid levels are seen in metabolically active states [3],[5].

Fundoscopy may reveal retinal streaks and radionuclide scans show increased uptake over all areas of involvement [6].

These lesions can be easily differentiated from other soft tissue calcifications, renal osteodystrophy, chondrosarcoma and parosteal osteosarcomas.

Dietary restriction of calcium and phosphate together with phosphate binding antacids is the treatment of choice [3]. Our case showed some unique features of tumoral calcinosis. The lobulated, non-tender, masses showed fluid-fluid levels in ultrasonography and homogenous calcific loculated appearance with intact adjacent bones in radiography. The fluid-fluid levels with calcific density are seen in metabolically active states as is reflected by the inorganic phosphate levels.

 
   References Top

1.Bishop AF, Destonet JM, Murphy WA et al, Tumoral Calcinosis: Case report and Review. Skeletal Radiol 1982; 8: 269 - 274.  Back to cited text no. 1    
2.Palmer PES, Tumoral Calcinosis. Br J Radiol 1966;39: 518-525.  Back to cited text no. 2    
3.Grainger RG, Allison D, Adam A, Dixon AK: Diagnostic Radiology: A Textbook of Medical Imaging. 4th Ed; Churchill Livingstone, Philadelphia, 2001: Vol -3, p- 2085.  Back to cited text no. 3    
4.Baldursson H, Evan EB, Dodge WF, Jackson WT, Tumoral Calcinosis with Hyperphosphatemia. A report of a family with incidence in 4 siblings. J Bone Joint Surg (Am) 1969; 51: 913 - 925.  Back to cited text no. 4    
5.Hug I, Guncaga J, Tumoral Calcinosis with Sedimentation Sign. Br J Radiol 1974; 47: 734 - 736.  Back to cited text no. 5    
6.Yaghmai I, Mirbod P, Tumoral Calcinosis Am J Roentgenol 1971; 111: 573 - 578.  Back to cited text no. 6    

Top
Correspondence Address:
K Hazarika
Department of Radiology, Gauhati Medical College, Guwahati-781032
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3]



 

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    Introduction
    Case Report
    Discussion
    References
    Article Figures

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