Hyperphosphatemic tumoral calcinosis: a rare differential of periarticular swelling

Authors

  • Sunil Nanjareddy Department of Orthopedics, Vydehi Institute of medical sciences and research, Whitefield, Bangalore, Karnataka, India
  • Rajashree Paidipatti Department of Orthopedics, Vydehi Institute of medical sciences and research, Whitefield, Bangalore, Karnataka, India
  • Vishwanath Muttagaduru Shivalingappa Department of Orthopedics, Vydehi Institute of medical sciences and research, Whitefield, Bangalore, Karnataka, India
  • Nuthan Jagadeesh Department of Orthopedics, Vydehi Institute of medical sciences and research, Whitefield, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20201571

Keywords:

Hyperphosphetemia, Myositis ossificans, Perarticular calcinosis, Tumour calcinosis

Abstract

Tumour calcinosis is a rare clinical and histopathological syndrome characterised by deposition of calcium deposits in different periarticular soft tissue regions of the body. It mainly manifest in childhood/ adolescence as a painless, firm to hard tumour like mass around the joints. Most common regions involved: Shoulder, elbow and hip. An 18 year old male patient presented to the opd with a history of pain and swelling over his left hip since 2 months. On examination, there was a diffuse tender swelling over the left greater trochanter, skin over the swelling was normal with no discharge, no dilated/ engorged veins. Range of motion of left hip was normal, no limb length discrepancies. X-ray: Showed a well define calcified mass over the greater trochanter with no osseous involvement. MRI revealed an encapsulated hypointense mass present posterior to the greater trochanter, mostly in the muscular plane. Lab findings revealed mild hyperphosphetemia. An aspirate from the swelling showed casseousmaterial. En mass removal was done and sent for biopsy. Biopsy showed features suggestive of tumoral calcinosis. Tumoral calcinosis is a distinct clinico-radiopathological entity characterised by soft tissue periarticular calcinosis which mimics a true neoplasm, associated with elevated levels of serum phosphate. It is an extremely rare condition which is seen in the adolescence and requires more studies regarding the surgical and medical management of the same.

Author Biographies

Sunil Nanjareddy, Department of Orthopedics, Vydehi Institute of medical sciences and research, Whitefield, Bangalore, Karnataka, India

    

Vishwanath Muttagaduru Shivalingappa, Department of Orthopedics, Vydehi Institute of medical sciences and research, Whitefield, Bangalore, Karnataka, India

                     

References

S. McClathatchie. Tumoral Calcinosis-un recongnized disease. 1969;153-5.

Inclan A, Leon P, Camejo MG. Tumoral calcinosis. J Am Medi Assoc. 1943 Feb 13;121(7):490-5.

Olsen KM, Chew FS. Tumoral calcinosis: pearls, polemics, and alternative possibilities. Radiographics. 2006 May;26(3):871-85.

Slavin RE, Wen J, Barmada A. Tumoral calcinosis -a pathogenetic overview: a histological and ultrastructural study with a report of two new cases, one in infancy. Int J Surg Pathol. 2012 Oct;20(5):462-73.

Prasad J, Malua S, Sinha DK, Hassan F, Tekriwal R. Tumoral calcinosis: a case report. Ind J Surg. 2007 Dec 1;69(6):251-3.

Narchi H. Hyperostosis with hyperphosphatemia: evidence of familial occurrence and association with tumoral calcinosis. Pediatrics. 1997 May 1;99(5):745-8.

Lyles KW, Burkes EJ, Ellis GJ, Lucas KJ, Dolan EA, Drezner MK. Genetic transmission of tumoral calcinosis: autosomal dominant with variable clinical expressivity. J Clini Endocrinol Metab. 1985 Jun 1;60(6):1093-6.

Lyles KW, Halsey DL, Friedman NE, Lobaugh B. Correlations of serum concentrations of 1, 25-dihydroxyvitamin D, phosphorus, and parathyroid hormone in tumoral calcinosis. J Clini Endocrinol Metab. 1988 Jul 1;67(1):88-92.

Zerwekh JE, Sanders LA, Townsend J, Pak CY. Tumoral calcinosis: Evidence for concurrent defects in renal tubular phosphorus transport and in 1α, 25-dihydroxycholecalciferol synthesis. Calcified Tissue Internat. 1980 Dec 1;32(1):1-6.

Varma S, Bhansali A, Gill SS, Kumari S, Singh S. Peri-articular ‘hard tumours’ in soft tissues. Postgrad Medi J. 1999 Aug 1;75(886):492-5.

Lufkin EG, Wilson DM, Smith LH, Bill NJ, Deluca HF, Dousa TP, et al. Phosphorus excretion in tumoral calcinosis: response to parathyroid hormone and acetazolamide. J Clini Endocrinol Metab. 1980 Apr 1;50(4):648-53.

Fathi I, Sakr M. Review of tumoral calcinosis: a rare clinico-pathological entity. World J Clini Cases: WJCC. 2014 Sep 16;2(9):409.

Lai LA, Hsiao MY, Wu CH, Wang TG, Özçakar L. Big gain, no pain: tumoral calcinosis. Am J Medi. 2018 Jan 1;131(1):45-7.

Downloads

Published

2020-04-27

How to Cite

Nanjareddy, S., Paidipatti, R., Shivalingappa, V. M., & Jagadeesh, N. (2020). Hyperphosphatemic tumoral calcinosis: a rare differential of periarticular swelling. International Journal of Research in Medical Sciences, 8(5), 1874–1877. https://doi.org/10.18203/2320-6012.ijrms20201571

Issue

Section

Case Reports