Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Jun 22 2021

Tumoral Calcinosis

Images calcinosis lateral_moved.jpg
  • summary
    • Tumoral Calcinosis is a rare, hereditary metabolic dysfunction of phosphate regulation associated with development of massive periarticular calcinosis in the extra-capsular soft tissues. Patients most commonly present with palpable lesions around the hip and shoulder.
    • Diagnosis is made radiographically with amorphous, cystic, circular, well-demarcated calcification in a periarticular location.
    • Treatment is observation for asymptomatic lesions. Surgical excision is indicated for symptomatic lesions associated with decreased function. 
  • Epidemiology
    • Demographics
      • more common in females and African-Americans
      • onset in childhood or early adolescence
    • Anatomic location
      • around joints, primarily the hip (trochanteric bursa is most common location) > shoulder
  • Etiology
    • Pathophysiology
      • unknown
        • inborn abnormality of phosphorus metabolism
          • FGF-23 defect leading to familial hyperphosphatemic tumoral calcinosis
  • Presentation
    • Symptoms
      • mass or swelling typically around joints
      • pain secondary to compression of normal surrounding structures
    • Physical exam
      • inspection
        • palpable mass around joint
  • Imaging
    • Radiographs
      • amorphous, cystic, lobular (circular or oval) well-demarcated calcification in periarticular location
      • direct involvement of the bones or joints is rare
    • CT
      • findings
        • may demonstrate fluid-fluid levels within some of these masses
          • calcium layering ("sedimentation sign")
        • or may have homogenous appearance
          • reduced metabolic activity, lower likelihood of growth
    • MRI
      • findings
        • diffuse, low signal intensity
        • bright, nodular pattern with alternating areas of high signal intensity and signal void
        • may demonstrate fluid-fluid levels (as with CT)
    • Bone scan
      • radionuclide bone scan may reveal intense uptake in the calcific masses
  • 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
  • Differentials
    • Calcinosis of renal failure (secondary tumoral calcinosis)
      • approximately 1% prevalence of periarticular masses
      • may occur independent of concomitant hyperparathyroidism
      • no radiologic/histologic differences with primary tumoral calcinosis
        • diagnosis is based on vitamin D levels, GFR, hyperphosphatemia, and history of chronic renal failure/long term dialysis
    • Calcific tendinitis
      • shoulder > hip > elbow > wrist > knee
      • occurs within tendon
      • no sedimentation of calcium (makes it different from tumoral calcinosis)
    • Synovial osteochondromatosis
      • occurs within joint/tendon sheath
      • "rings and arcs" and intra-articular location (makes it different from tumoral calcinosis)
    • Myositis ossificans and heterotopic ossification
      • not lobular
      • evolves rapidly from faint calcification to organized cartilage and bone in 6 weeks
      • late lesions of HO have well developed cortex and medullary cavity
    • Gout
      • may have hyperuricemia
      • focal erosions of underlying bone
  • 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 excision is required to decrease the rate of local recurrence
        • results
          • risk of recurrence
            • if lesion is poorly circumscribed
            • if excision is performed while lesion is actively growing
  • Complications
1 of 1
1 of 4
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options