A 23-year-old patient with secondary tumoral calcinosis: Regression after subtotal parathyroidectomy: A case report

Non-Classical Effects of FGF23: Molecular and Clinical Features

This article reviews the role of fibroblast growth factor 23 (FGF23) protein in phosphate metabolism, highlighting its regulation of vitamin D, parathyroid hormone, and bone metabolism. Although it was traditionally thought that phosphate-calcium homeostasis was controlled exclusively by parathyroid hormone (PTH) and calcitriol, pathophysiological studies revealed the influence of FGF23. This protein, expressed mainly in bone, inhibits the renal reabsorption of phosphate and calcitriol formation, mediated by the α-klotho co-receptor. In addition to its role in phosphate metabolism, FGF23 exhibits pleiotropic effects in non-renal systems such as the cardiovascular, immune, and metabolic systems, including the regulation of gene expression and cardiac fibrosis. Although it has been proposed as a biomarker and therapeutic target, the inhibition of FGF23 poses challenges due to its potential side effects. However, the approval of drugs such as burosumab represents a milestone in the treatment of FGF23-related diseases.

New method of local adjuvant therapy with bicarbonate Ringer's solution for tumoral calcinosis: A case report

BACKGROUND

Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues, occurring in hemodialysis patients. Calcium phosphate crystals are mainly composed of hydroxyapatite, which is highly infiltrative to tissues, thus making complete resection difficult. An adjuvant method to remove or resolve the residual crystals during the operation is necessary.

CASE SUMMARY

A bicarbonate Ringer's solution with bicarbonate ions (28 mEq/L) was used as the adjuvant. After resecting calcium phosphate deposits of tumoral calcinosis as much as possible, while filling with the solution, residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field. A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders, bilateral hip joints, and the right foot. A shoulder lesion was resected, but the calcification remained and early re-deposition was observed. Considering the difficulty of a complete rection, we devised a bicarbonate dissolution method and excised the foot lesion. After resection of the calcified material, the residual calcified material was washed away with bicarbonate Ringer's solution.

CONCLUSION

The bicarbonate dissolution method is a new, simple, and effective treatment for tumoral calcinosis in hemodialysis patients.

Different outcomes following parathyroidectomy in patients with uremic tumoral calcinosis: two case reports

BACKGROUND

Uremic tumoral calcinosis (UTC) is a rare complication in hemodialysis patients, whose mechanism remains incompletely understood. We report two cases with UTC who experienced completely different patterns of regression following parathyroidectomy, although there were no significant differences in serum calcium levels, parathyroid hormone, or phosphorus production between the two patients.

CASE PRESENTATION

Case 1 had a substantial improvement in soft tissue calcification. However, in Case 2, one calcified mass was partially absorbed, while the others were aggravated with severe microvascular calcification and subcutaneous extravascular calcification. Whole-exome sequencing data revealed five mutation sites associated with atherosclerosis.

CONCLUSION

The different outcomes in UTC patients after PTX are rare. Further studies are required to elucidate the mechanism of paradoxical changes occurring in patients with UTC after parathyroidectomy.

Hyperphosphatemic Tumoral Calcinosis after Total Knee Arthroplasty

We report a case of hyperphosphatemic tumoral calcinosis (TC) that occurred after total knee arthroplasty. A 64-year-old Japanese man presented with painful swellings in both shoulders, the left elbow, and the right hip that developed after he underwent total knee arthroplasty (TKA). The pathology of the patient's bone at the time of TKA included a thick osteoid seam with calcareous deposition at the margin of the trabecular bone, which is not generally seen in osteoarthritis. Computed tomography scans of the swollen joints demonstrated leaflet and amorphous calcification masses around the joints. We diagnosed the patient with TC. The present case highlights that TC lesions are rare but should be considered in the differential diagnosis of subcutaneous soft and hard masses around the joint.

Tumoral calcinosis: Diffuse multifocal form in hemodialysis patients. Two case reports

Orthopedic surgeons are often consulted for diagnosis of MASS syndrome, imaging showing periarticular calcification, or joint stiffness. Such presentations in a dialyzed patient should suggest tumoral calcinosis, which is a rare complication of dialysis, often diagnosed wrongly or late. It is often associated with calcium phosphate balance disorder, in which treatment is difficult and must take account of known contributing factors: severe hyperparathyroidism, increased phosphocalcic product, therapeutic calcium and vitamin D overload, and bone turnover slowed for varying reasons. We report a clinical, radiological and therapeutic description of two cases of tumoral calcinosis, which consists in deposits of hydroxyapatite, the crystalline form of calcium phosphate, in diffuse multifocal periarticular locations, inducing both esthetic and functional damage.

Multiple ectopic calcifications in subcutaneous tissues with chronic renal failure: A case report

BACKGROUND

Multiple tumor-like ectopic calcifications is a rare syndrome characterized by subcutaneous mass deposits of calcium phosphate in periarticular tissues. Although several cases of the surgical treatment of tumoral calcinosis have been reported, the present case is unique in that multiple ectopic calcifications in subcutaneous tissues were found in a hemodialysis patient who had been operated on a total of five times within a period of 1.5 years.

METHODS

A hemodialysis 60-year-old male presented with multiple tumor-like ectopic calcifications bilateral in the shoulders, right buttock and right thigh. He had been operated on a total of five times within a period of 1.5 years; the operations included a subtotal parathyroidectomy with parathyroid autotransplantation in the right forearm.

RESULTS

Complete excisions of the ectopic calcifications were performed in the left shoulder, right buttock and right thigh, without signs of recurrence in the same sites at follow-up. Incomplete excision of the ectopic calcification in the right shoulder resulted in recurrence in the same site, and the patient was operated on two more times 1.5 years following the initial surgery. Subtotal parathyroidectomy with parathyroid autotransplantation decreased serum levels of PTH, but the levels of serum calcium and phosphorus remained unchanged post-surgery, which appeared not to inhibit the recurrence of ectopic calcification in patients with CRF.

CONCLUSIONS

If conservative therapy failed, then early and complete surgical excision may be a good therapeutic option.