| Introduction |
 Rare and poorly understood entity characterized by calcium salt deposits in the extra-capsular soft tissues - Epidemiology
- demographics
- more common in females and African-Americans
- onset usually in childhood or early adolescence
- location
- typically occurs around joints, primarily the hip and shoulder
- Pathophysiology
- unknown
- there is evidence suggesting an inborn abnormality of phosphorus metabolism
- Associated conditions
- calcinosis of renal failure
- radiographically similar appearance to tumoral calcinosis, but not as strongly associated with hip and shoulder distribution
- renal etiology differentiates it from tumoral calcinosis
- associated with hyperphosphatemia, chronic renal failure, and long term dialysis
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| Presentation |
- Symptoms
- mass or swelling typically around joints
- pain secondary to compression of normal surrounding structures
- Physical exam
- inspection
- palpable mass around joint
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| Imaging |
- Radiographs
- circular or oval, well-demarcated masses of calcium around joints
- direct involvement of the bones or joints is rare
- CT
- may demonstrate fluid-fluid levels within some of these masses
- MRI
- may demonstrate fluid-fluid levels within some of these masses
- Bone scan
- radionuclide bone scan may reveal intense uptake in the calcific masses
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| Studies |
- Labs
- normal or slightly elevated renal and parathyroid function
- normal or slightly elevated serum calcium, phosphorus, uric acid, and alkaline phosphatase
- Histology
- lobulated soft tissue masses with well-defined capsules and thick septae
- masses are filled with calcareous material (calcium phosphate, calcium carbonate and calcium hydroxyapatite) and fluid
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| Treatment |
- Nonoperative
- observation
- indications
- treatment of choice for non-symptomatic lesions
- Operative
- complete surgical excision
- indications
- treatment of choice for symptomatic lesions
- technique
- complete surgical excisionis required to decrease the rate of local recurrence
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| IBank |
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Location
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Xray
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Xray
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CT
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B.Scan
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MRI
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MRI
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Histo(1)
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| Case A |
femur |
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| Case D |
femur |
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(1) - histology does not always correspond to clinical case
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Please Rate Educational Value!
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5.0
t-8077
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Average 5.0 of 2 Ratings
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Qbank (2 Questions)
TAG
(OBQ08.174)
A 59-year-old dialysis-dependent diabetic female complains of palpable bump over her right hip. She denies pain in the hip and has not noticed any other bumps on any of her extremities. On physical exam, the bump is nontender and does not limit range of motion. A radiograph is provided in Figure A. What is the most likely diagnosis?
Review Topic
DISCUSSION:
The radiograph demonstrates calcifications throughout the abductors of the right hip consistent with calcinosis. Calcinosis of renal failure can mimic tumoral calcinosis. However, the two are separate entities. Tumoral calcinosis is a hereditary disorder primarily of African-Americans resulting in spontaneous peri-articular calcifications. It most frequently affects the hip and shoulder. Buschmann et al presents a case report of tumoral calcinosis and reviews the evaluation, diagnosis, and treatment. Illustrations A-C are examples of tumoral calcinosis, synovial chondromatosis, and parosteal osteosarcoma, respectively. Clinical history and physical exam are important to differentiate similar appearing lesions.
REFERENCES:
1.
Buschmann WR, Myers W, Sager G. Tumoral calcinosis. Case presentation and review. Orthop Rev. 1989 Apr;18(4):440-2.
PMID:2654827 (Link to Abstract)
2.
Bullough P. Bone Diseases resulting from disturbances in mineral homeostasis. Orthopaedic Pathology, ed 3, London, Mosby-Wolfe, 1997, pp 177-200
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Please Rate Educational Value!
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3.0
q-560
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Average 3.0 of 12 Ratings
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TAG
(OBQ07.29)
A 30-year-old African-American female presents to your clinic with right hip swelling. These symptoms have been present for over 3 years, but this is the first time she is seeking treatment. Figures A-E show radiographs, an MRI, and histology. What is the most likely diagnosis?
Review Topic
DISCUSSION:
The history and imaging studies are most consistent with tumoral calcinosis. Tumoral calcinosis is a relatively rare disorder of uncertain etiology most commonly seen in people of African descent and females. Metabolic defects, collagen vascular disorders, and trauma have been associated with the development of these lesions. Lesions grow slowly and rarely cause pain. The histologic appearance is characterized by loculated calcific debris surrounded by a fibrous stroma. Surgical removal is the treatment of choice for symptomatic lesions and incomplete removal is associated with recurrence. The review by Martinez discusses the new recognition and understanding of this disease as described above.
REFERENCES:
1.
Martinez S. Tumoral calcinosis: 12 years later. Semin Musculoskelet Radiol. 2002 Dec;6(4):331-39. Review.
PMID:12541190 (Link to Abstract)
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Please Rate Educational Value!
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2.0
q-690
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Average 2.0 of 13 Ratings
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Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions,
Personal Observations, and Biomechanic Studies)
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Buschmann WR, Myers W, Sager G. Tumoral calcinosis. Case presentation and review. Orthop Rev. 1989 Apr;18(4):440-2.
PMID:2654827 (Link to Abstract)
Textbooks
- Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
- AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
- Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
- Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
- Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
- Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Undefined
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Bullough P. Bone Diseases resulting from disturbances in mineral homeostasis. Orthopaedic Pathology, ed 3, London, Mosby-Wolfe, 1997, pp 177-200
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Martinez S. Tumoral calcinosis: 12 years later. Semin Musculoskelet Radiol. 2002 Dec;6(4):331-39. Review.
PMID:12541190 (Link to Abstract)
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