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Eldirdiri S, Eldirdiri S, Elbashir IBA, Aldaw NF, Abd Allah HMA, Ibrahim MY. Idiopathic tumoral calcinosis of the left thigh: a case report. J Surg Case Rep 2025; 2025:rjaf171. [PMID: 40161886 PMCID: PMC11952900 DOI: 10.1093/jscr/rjaf171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 03/07/2025] [Indexed: 04/02/2025] Open
Abstract
Idiopathic tumoral calcinosis is a very rare benign condition characterized by pathological deposition of calcium phosphate crystals into the soft tissues, particularly into the peri-articular regions. This case report narrates the first reported case of idiopathic tumoral calcinosis in Sudan. A 38-year-old Sudanese female from Gadarif presented with a history of progressive enlargement of the left thigh swelling over a period of 1 year, which was painless. Clinical examination revealed a firm and well-circumscribed mass without overlying skin changes. Imaging revealed calcification with a characteristic "chicken wire" pattern in X-rays, and histopathology confirmed lobulated calcium deposits surrounded by fibrous tissue and foreign body giant cell reactions without malignancy. The patient underwent complete surgical excision of the mass under spinal anesthesia, and her recovery was uneventful. This case highlights the need for recognition of idiopathic tumoral calcinosis in the differential diagnosis of soft tissue masses, especially in the region where these are underreported.
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Affiliation(s)
- Sami Eldirdiri
- Department of Surgery, University of Gadarif, Gadarif, Sudan
| | | | | | - Nahid F Aldaw
- Head Department of Pathology, University of Gadarif, Gadarif, Sudan
| | | | - Mohamed Y Ibrahim
- Pediatric Surgery Center, National Ribat University Hospital, Khartoum, Sudan
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Kouba L, Fabi A, Glatz K, Thoma A, Lariu A, Burger M, Schweizer T, Schaefer DJ, Kappos EA. The value of perforator flap reconstruction in painful soft tissue calcifications. Clin Exp Med 2024; 24:189. [PMID: 39136799 PMCID: PMC11322213 DOI: 10.1007/s10238-024-01421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/27/2024] [Indexed: 08/16/2024]
Abstract
Soft tissue calcifications frequently cause debilitating pain and functional impairments, considerably affecting patients' quality of life. As they are rare entities, evidence remains sparse, especially regarding treatment effectiveness and recurrence rates. While both pharmacological and surgical treatments may alleviate symptoms, complete resection is currently believed to prevent long-term recurrence of deposits. To improve understanding and raise awareness for soft tissue calcifications, the goal of this study was to review the current state of treatment and to compare benefits and possibilities of flap reconstruction versus simple excision in improving quality of life. Furthermore, we include a successful case report of complete resolution of symptoms following quadruple perforator flap reconstruction. By systematic literature review, studies published in MEDLINE between 1980 and 2024 reporting on surgical treatment and outcome of soft tissue calcifications were included, in addition to a detailed description of our case report. A total of 53 studies reporting on 197 patients with soft tissue calcifications were included. Simple surgical excision was the most commonly (85.9%) employed procedure, demonstrating a substantial recurrence rate of 13.3%. In contrast, no patients who underwent radical excision experienced recurrence. Dermal matrix grafts and flap reconstruction were successfully used in patients requiring substantial tissue coverage, highlighting their value in complex defect reconstruction following radical excision. The combination of complete surgical resection and flap reconstruction reduces recurrence rates and improves postoperative outcomes and quality of life of these patients, supporting early radical surgical intervention as the gold standard treatment for soft tissue calcifications.
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Affiliation(s)
- Loraine Kouba
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Reconstructive Basel, Switzerland
| | - Adriano Fabi
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Reconstructive Basel, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Kathrin Glatz
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Pathology, University Hospital Basel, Basel, Switzerland
| | - Anna Thoma
- Department of Rheumatology and Pain Medicine, Bethesda Hospital Basel, Basel, Switzerland
| | - Ana Lariu
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Reconstructive Basel, Switzerland
- Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
| | - Maximilian Burger
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Reconstructive Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Thierry Schweizer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Reconstructive Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Reconstructive Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Elisabeth A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Reconstructive Basel, Switzerland.
- Faculty of Medicine, University of Basel, Basel, Switzerland.
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Waltenspül C, Spies CK, Janzen J. Tumoral Calcinosis at a Finger Metacarpophalangeal Joint. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024. [PMID: 38977005 DOI: 10.1055/a-2324-6535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
A 51-year-old patient presented with a painful swelling palmar to the metacarpophalangeal joint of the ring finger. A round tumor was detected using X-rays and MRI. After excision, tumoral calcinosis could be verified histologically.
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Affiliation(s)
| | | | - Jan Janzen
- Histopathologie und VascPath, Gümligen, Schweiz
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Ivanova NG. A Sole Case of the FGF23 Gene Mutation c.202A>G (p.Thr68Ala) Associated with Multiple Severe Vascular Aneurysms and a Hyperphosphatemic Variant of Tumoral Calcinosis-A Case Report. Life (Basel) 2024; 14:613. [PMID: 38792634 PMCID: PMC11123361 DOI: 10.3390/life14050613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Tumoral calcinosis is an extremely rare genetic disease caused by mutations in three genes, GALNT3, FGF23, and KL, which disrupt phosphorus metabolism. The hallmark of this condition is the formation of tumors in the soft tissues around the joints. Other phenotypic features of tumoral calcinosis are dental involvement and brain and vascular calcifications. The clinical case reported herein presents for the first time to the scientific community the c.202A>G (p.Thr68Ala) mutation of the FGF23 gene, associated with a hyperphosphatemic variant of tumoral calcinosis and multiple severe vascular aneurysms. A female patient underwent multiple surgeries for tumor formations in her soft tissues that first appeared at the age of 12 months. On this occurrence, the patient was found to have hyperphosphatemia, low phosphate clearance, increased tubular reabsorption with normal levels of total and ionized calcium, vitamin D3, and parathyroid hormone, and no effect of treatment with sevelamer hydrochloride and a low-phosphate diet. At the age of 39, the patient underwent imaging studies due to edema and a pulsating formation in the neck area, which revealed multiple vascular aneurysms with thrombosis, for which she received operative and interventional treatment. In this connection, and because of the established phosphorus metabolism disturbance, a genetic disease was suspected. The sequence analysis and deletion/duplication testing of the 358 genes performed on this occasion revealed that the woman was homozygous for a variant of the c.202A>G (p.Thr68Ala) mutation of the FGF23 gene. The established mutation is not present in population databases. The presented clinical case is the first and only one in the world to demonstrate the role of this type of FGF23 gene mutation in the development of a hyperphosphatemic variant of tumoral calcinosis characterized by aggressive formation of multiple vascular aneurysms.
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Affiliation(s)
- Nevena Georgieva Ivanova
- Department of Urology and General Medicine, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria; ; Tel.: +35-98-8913-0416
- St Karidad MHAT, Karidad Medical Health Center, 4004 Plovdiv, Bulgaria
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Lee SH, Kim SH, Choi SJ, Lee YK. Cutaneous Calcified Mass of Foot in Pseudohypoparathyoidism: Case Report. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:595. [PMID: 38674241 PMCID: PMC11052086 DOI: 10.3390/medicina60040595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/18/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
Soft tissue calcifications frequently appear on imaging studies, representing a prevalent but non-specific discovery, varying from a local reaction without clear cause to suggesting an underlying systemic condition. Because calcifications like these can arise from various causes, an accurate differential diagnosis is crucial. Differential diagnosis entails a methodical assessment of the patient, encompassing clinical presentation, medical history, radiological and pathological findings, and other pertinent factors. Through scrutiny of the patient's medical and trauma history, we can refine potential causes of calcification to vascular, metabolic, autoimmune, neoplastic, or traumatic origins. Furthermore, routine laboratory assessments, including serum levels of calcium, phosphorus, ionized calcium, vitamin D metabolites, and parathyroid hormone (PTH), aid in identifying metabolic etiologies. We describe a rare occurrence of osteoma cutis in a 15-year-old female patient with a history of pseudohypoparathyroidism (PHP) and Albright's hereditary osteodystrophy (AHO). The patient presented with a painful mass on the lateral side of her left foot. The diagnosis was based on medical history, laboratory tests, and imaging, leading to an excisional biopsy and complete pain relief post-surgery. Understanding such rare occurrences and related conditions is crucial for accurate diagnosis and management.
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Affiliation(s)
| | | | | | - Young Koo Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Gyeonggi-do, Bucheon-si 14584, Republic of Korea; (S.H.L.); (S.H.K.); (S.J.C.)
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Sukun A, Weber MA. [Slowly progressive, painful swelling of the right thigh in a dialysis patient]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:120-124. [PMID: 36418645 DOI: 10.1007/s00117-022-01095-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/25/2022]
Affiliation(s)
- A Sukun
- Exchange Programme For Musculoskeletal Radiology Fellowships, European School of Radiology (ESOR), Wien, Österreich. .,Baskent University Alanya Application and Research Center, Antalya, Türkei. .,Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - M-A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
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