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PubMed2002

Uremic tumoral calcinosis of the foot mimicking infection.

Uremic tumoral calcinosis is an uncommon, benign condition characterized by slow-growing calcified periarticular soft tissue masses of varying size. We describe two patients with chronic renal failure on hemodialysis presenting uremic tumoral calcinosis, one in the fifth toe of the right foot and the other in the dorsum of the left foot between the first and second metatarsals. Excision of the calcic masses and parathyroidectomy were successfully performed in both patients. These cases are unusual in their rapid onset, mimicking acute infection. Differential diagnosis, radiological features and therapy are discussed.

Acute Disease↗
PubMed2005

Iatrogenic calcinosis cutis--a rare differential diagnosis of soft-tissue infection in a neonate: a case report.

This case report describes a rare differential diagnosis of soft-tissue infection in a neonate. Fever, pain, inflammation, and acute tenderness in the limb of a neonate signify acute infection or osteomyelitis unless proved otherwise. Iatrogenic calcinosis cutis presents with similar symptoms and signs; its diagnosis may be easily confused with an infective condition by an unwary orthopaedic surgeon. This report aimed to raise doctors' awareness on the presentation, aetiopathogenesis, and course of the relatively rare iatrogenic calcinosis cutis.

Calcinosis↗
PubMed1983

Hyperphosphatemic tumoral calcinosis: effects of phosphate depletion on vitamin D metabolism, and of acute hypocalcemia on parathyroid hormone secretion and action.

In hyperphosphatemic tumoral calcinosis, plasma 1,25-dihydroxyvitamin D [1,25(OH)2D] levels are inappropriately elevated, suggesting an abnormality in vitamin D metabolism. To define this abnormality further, we measured vitamin D metabolites in two patients and four controls before and after phosphate depletion. The patients showed elevated plasma levels of 1,25(OH)2D in the basal state. Phosphate depletion reduced serum phosphate in patients from a mean of 6.1 to 2.6 mg/dl; this was accompanied by a rise in plasma 25-hydroxyvitamin D from 33.6 to 41.9 ng/dl, and in 1,25(OH)2D from 67.7 to 93.2 pg/ml. The absolute rise in 1,25(OH)2D was similar to that of controls. EDTA infusion produced a normal increase of serum immunoreactive PTH levels and urinary cAMP excretion. In this form of tumoral calcinosis, 1,25(OH)2D levels are elevated despite hyperphosphatemia, normal immunoreactive PTH, and normal serum calcium concentrations, suggesting an abnormality in the regulation of 1,25(OH)2D synthesis or metabolism, or alternatively, another undefined stimulus for 1,25(OH)2D synthesis. These patients appear to have concurrent abnormalities of renal tubular phosphate transport and vitamin D metabolism.

Calcinosis↗
PubMed1992

Protective effects of benidipine hydrochloride (KW-3049), a calcium antagonist, against experimental arterial calcinosis and endothelial dysfunction in rats.

Protective effects of benidipine hydrochloride (KW-3049) against arterial calcinosis and its possible mechanisms of action have been investigated. Arterial calcinosis was induced in rats by combined administration of vitamin D2 (1050000 IU/kg, s.c.) and nicotine (12.5 mg/kg, p.o., b.i.d.) for 6 successive days. Calcium antagonists, benidipine or nifedipine, were given orally twice a day during the same period. The aortic calcium content in vitamin D2 and nicotine-treated (control) rats increased to about 25 times that in normal rats, accompanying an increase of serum calcium level. Benidipine (10 mg/kg, p.o., b.i.d.) reduced the aortic calcium content to about 18% of control rats without reducing the serum calcium level. Although the presence of aortic endothelial cells was observed under light microscopy in control rats, their surfaces were degenerated under scanning electron microscopy. Benidipine exerted a protective effect against these degenerative changes. Acetylcholine-induced endothelial dependent relaxation was attenuated in control rats, compared with that in normal rats. Benidipine significantly improved this attenuation of the relaxation. These results suggest that the anticalcinotic effect of benidipine is accompanied by its protective effect on endothelial cells.

Acetylcholine↗
PubMed1994

[Effect of traditional Chinese medicine (dai-saiko-to) on experimental calcinosis].

To clarify the anti-calcinosis actions of traditional Chinese medicine (Dai: Dai-saiko-to) and estradiol benzoate (E2), 7-week or retired (about 6-months-old) female rats were treated with Vit. D2 (1.75 x 10(5) I.U./kg b.w./day) for 4 days, and then were fed a basal diet containing Dai (at ten times the medical dose in humans) or were injected i.p. with E2 (at the medical dose in humans) for 6 weeks. The following results were obtained: 1) Dai did not improve Ca and P metabolism in experimental calcinosis of 7-week female rats; 2) in retired female rats, Dai decreased both P in the heart and the ratio of Ca to P in bone, similar to the treatment with E2. Dai, as well as E2, seemed to nomalize Ca and P metabolism disturbed by Vit. D2 treatment.

Animals↗
PubMed1980

Tumoral calcinosis: scintigraphic studies of an affected family.

Tumoral calcinosis is a rare, familial ectopic calcification syndrome associated with hyperphosphataemia. A family in which seven of 13 siblings had demonstrable, clinical, radiological and pathological findings of tumoral calcinosis was evaluated. The purposes were to compare the efficacy of bone scintiscans with serum phosphorus determination in detecting subclinical disease early in asymptomatic siblings and to assess therapeutic results in affected family members following initiation of phosphate depletion therapy. History, physical examination, serum calcium, serum phosphorus and bone scintiscans were performed in 12 of 13 siblings. All the affected siblings had markedly elevated serum phosphorus levels and abnormal bone scintiscans while the unaffected siblings had normal serum phosphorus levels and normal bone scintiscans. All the siblings, affected and unaffected, were normocalcaemic. After initiation of phosphate depletion therapy, gross changes in the appearance of lesions were detected on bone scintiscans. Serum phosphorus levels likewise showed a modest decline, although still remaining in the hyperphosphataemic range. In conclusion, bone scintiscans and serum phosphorus determinations are equally sensitive in detecting subclinical disease. However, the scintiscans are helpful in assessing not only the extent of the disease, but also whole-body and regional changes following any therapeutic interventions.

Adolescent↗
PubMedDate not supplied

Primary hyperparathyroidism in an infant with three parathyroid glands and pulmonary calcinosis.

A 2 month-old male infant presented with severe hypercalcemia due to parathyroid hyperplasia. A total parathyroidectomy and partial heterotopic autotransplantation were carried out. Hypercalcemia recurred two months later. Normocalcemia was re-established after removing one half of the implanted tissue. Despite two separate surgical explorations and several imaging studies, including 99mTc-sestamibi scintigraphy, ultrasonography, and MRI, only three parathyroid glands were found. Severe pulmonary calcinosis has not previously been reported in children with PHPT. In conclusion, developmental variations of the parathyroid glands may be difficult to identify with present imaging techniques. This may pose difficulties in management of PHPT. The present report describes pulmonary calcinosis as a sequela which can cause additional morbidity in these infants.

Adult↗
PubMedDate not supplied

Ureteral calcinosis in juvenile dermatomyositis: successful precocious surgical management.

We report a successful surgical intervention to repair bilateral ureteral strictures in a child with juvenile dermatomyositis (JDM) and ureteral calcinosis. This is the fourth reported case in medical literature. A 9-year-old-girl with severe JDM, a rare connective tissue disease characterized by skin and muscles vasculitis, was under immunosuppressive therapy. In the course of the disease, she presented recurrent urinary tract infections. Bilateral ureteral dilation was detected by ultrasound (US) and intravenous pyelogram (IVP). CT scan showed bilateral ureteral calculus. Ureteroscopy revealed bilateral ureteral calcinosis, confirmed by histopathological analysis. Bilateral double-J stents were placed, resulting in transient improvement of ureteral dilation and infection, but only the surgical removal of abnormal ureteral portions was successful. In conclusion, endourological approach is recommended for diagnosis of urinary tract involvement by JDM because radiological evaluation can be misleading. The immunosuppressive treatment and the resection of damaged ureteral segments have allowed the control of urinary complications.

Calcinosis↗
PubMed1999

Calcinosis cutis and intestinal pseudoobstruction in a patient with adult onset Still's disease associated with recurrent relapses of disordered coagulopathy.

Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown origin, characterized by a typical spiking fever, evanescent salmon-colored rash, polyarthralgia, and myalgia. Calcinosis cutis and gastrointestinal involvement have rarely been noted in AOSD. We herein describe a 54-year-old woman who demonstrated repeated disseminated intravascular coagulation (DIC), and adult respiratory distress syndrome (ARDS), associated with AOSD. The patient also revealed a remarkable degree of digital calcinosis cutis and intestinal pseudoobstruction. A connective tissue disease, such as systemic sclerosis, might have been the underlying factor in the latter two symptoms.

Anticoagulants↗
PubMed2003

Tumoral calcinosis in a dog with chronic renal failure.

A 2-year-old male German shepherd dog in poor bodily condition was evaluated for thoracic limb lameness due to a large, firm mass medial to the left cranial scapula. Radiography revealed several large cauliflower-like mineralized masses in the craniomedial left scapula musculature, pectoral region and bilaterally in the biceps tendon sheaths. Urinalysis, haematology and serum biochemistry showed that the dog was severely anaemic, hyperphosphataemic and in chronic renal failure. The dog was euthanased and a full post mortem performed. A diagnosis of chronic renal failure with secondary hyperparathyroidism was confirmed. The mineralised masses were grossly and histopathologically consistent with a diagnosis of tumoral calcinosis. Tumoral calcinosis associated with chronic renal failure that does not involve the foot pads is rarely seen.

Animals↗
PubMedDate not supplied

Calcinosis circumscripta of the thoracic wall in a German shepherd dog.

Calcinosis circumscripta of the left thoracic wall was diagnosed in a six-month-old, female German shepherd dog by thoracic radiography and ultrasonographic-guided biopsy. The puppy developed the lesion following a left thoracotomy to repair a patent ductus arteriosus. Complete resolution occurred following surgical excision of the lesion. Calcinosis circumscripta associated with routine surgical manipulation and postoperative inflammation has been reported rarely but should be suspected when a focal, mineralized lesion occurs at a previous surgical site, especially in German shepherd dogs.

Animals↗
PubMed2006

Tumoral calcinosis of the hand: three unusual cases with painful swelling of small joints.

Tumoral calcinosis is a rare ectopic calcification syndrome characterized by irregular soft tissue masses originally described as being found mainly in large joints. We report 3 cases of tumoral calcinosis that occurred in unusual locations, the metacarpophalageal and proximal interphalangeal joints of the hand. The patients were women who ranged in age from 26 to 44; all presented with complaints of painful swelling of the joints. Laboratory tests demonstrated normal serum phosphate and calcium levels. Radiologic examination disclosed para-articular calcified masses. On surgical excision, the deep-seated calcified masses were attached to collateral ligaments of the joints. Milky and chalklike fluid was released during surgery. The masses measured 1.5, 0.9, and 0.8 cm in length and had irregular surfaces. Microscopically, the masses had fibrous capsule and the inner small cystic spaces that contained granular, calcified material. These cysts contained proliferating capillaries, mononuclear lymph plasma cells, and giant cells. No recurrences were found in any of the patients during the follow-up periods.

Adult↗
PubMed1998

Tumoral calcinosis-like lesion of the foot. A case report.

Tumoral calcinosis-like lesions of the foot are a pedal manifestation of end-stage renal disease. Although they are benign, they have the potential to cause significant morbidity because of their invasive nature. Following a brief description of tumoral calcinosis-like lesions, the authors provide an illustrative case presentation including radiographs, magnetic resonance images, surgical photographs, and histopathology.

Adult↗
PubMed2001

Lingual calcinosis circumscripta in a captive sitatunga.

Calcinosis circumscripta (CC) was found in a 10-yr-old female sitatunga (Bovidae; Tragelaphus spekei). At necropsy, there were two white coalescing nodules (3 x 5 x 2 cm, 2 x 2 x 1.5 cm) on the ventral side of the tongue. The cut surface of the nodules had multiple, well-circumscribed loculi with chalky appearance and gritty consistency, separated by thin strands of connective tissue. Histologically, the nodules contained multiple loculi of various sizes and shapes, which consisted of amorphous material that was pale basophilic with H&E stain, surrounded by fibrous connective tissue. Around the loculi were numerous foreign body giant cells and epithelioid macrophages; occasional lymphocyte aggregations also were seen. The amorphous material was positive for PAS and von Kossa's stain. Calcinosis circumscripta is rare in the Bovidae.

Animals↗
PubMed1976

[Idiopathic calcinosis of the skin].

Biochemical, radiologic and enzymatic studies are carried out in a case of idiopatic calcinosis cutis. The diagnosis has been obtained by exclusion of the other forms of calcinosis cutis. Therefore we believe that the disease may evolue in the future to a sistemic disease probably "collagen disease". However, today there is no evidence for this.

Calcinosis↗
PubMedDate not supplied

Tumoral calcinosis: a case report.

Tumoral calcinosis is a rare disorder with the calcified masses in subcutaneous tissues. We report herein a nine-year-old girl, in whom the calcified lesions bilaterally involved the soft tissues in the anterior part of the knee joint. Serum calcium and phosphorus levels were in normal ranges and there was no family history. Surgical excision was performed and recurrence was not observed in early follow-up. Review of the literature shows that only clinical and radiological appearance of tumoral calcinosis are generally agreed while its epidemiology, etiology and treatment are still under discussion.

Calcinosis↗