Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obervation Letter
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter To Editor
2008:74:3;282-283
doi: 10.4103/0378-6323.41394
PMID: 18583815

Tumoral calcinosis

Saurabh Jindal, Amar Surjushe, Prajct Sao, DG Saple
 Department of Dermatology, Venereology and Leprosy, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India

Correspondence Address:
Saurabh Jindal
6-D Malaygiri Apartments, Anushakti Nagar, Mumbai - 400 094
India
How to cite this article:
Jindal S, Surjushe A, Sao P, Saple D G. Tumoral calcinosis. Indian J Dermatol Venereol Leprol 2008;74:282-283
Copyright: (C)2008 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Calcinosis cutis, a group of disorders in which calcium is deposited in the skin is of four types: metastatic, dystrophic, idiopathic and intraepidermal calcified nodules. [1] Tumoral calcinosis is a special form of idiopathic calcinosis which affects adolescents and young adults [2] and is characterized by massive subcutaneous deposits of calcium phosphate near the joints such as hips, shoulders, elbows, wrists, feet and hands. The deposits consist of pleomorphic calcium phosphate (hydroxyapatite) crystals.

A 26 year-old married male presented with gradually increasing, painless, bony, hard masses over both the elbows and around the right hip joint prevalent since the last two years. There was no history of excessive milk or antacid intake, endocrinal abnormalities, or any history suggestive of any connective tissue disease. There was also no history of any similar condition in the family members.

On examination, there were firm-to-hard, nontender, irregular, tumorous masses over the lateral aspect of the right gluteal region measuring 15 x 15 cm, and over both elbows measuring about 10 x 8 cm with overlying skin showing atrophic scars. There was minimal restriction of movements at the joints [Figure - 1]. Systemic examination results were normal.

Hemogram, liver and renal function tests, and the erythrocyte sedimentation rate were normal. Serum phosphorus level was 6 mg% (normal range: 2-4.5 mg%). Serum calcium, uric acid, alkaline phosphatase, parathyroid hormone, calcitonin levels were normal. Antinuclear antibodies and the rheumatoid factor were absent. Radiographs showed large, lobulated, radio-opaque, soft tissue masses of calcific density with radiolucent septae in the juxta-articular position of both elbows and the right hip. Magnetic resolution imaging (MRI) of the right hip showed foci of calcification with infiltration into the gluteus medius and quadratus femoris [Figure - 2]. Histopathology from the elbow showed deeply basophilic amorphous granular material surrounded by dense fibrous tissue and infiltration [Figure - 3]. Debulking of the elbow regions was done and the patient is now on regular follow-up to detect any recurrence.

Tumoral calcinosis was first described in 1899. [3] The pathogenesis is obscure but the basic defect is thought to be in the proximal renal tubular cell with an elevated renal phosphate reabsorption threshold and increased production of 1, 25-dihydroxyvitamin D. [4] It is classified into three types depending upon the pathogenesis: primary normophosphatemic tumoral calcinosis (NPTC), primary hyperphosphatemic tumoral calcinosis (PHTC) and secondary tumoral calcinosis. [5] Our case is of subtype 2 having hyperphosphatemia with normal levels of serum calcium, parathyroid hormone and alkaline phosphatase. Tumoral calcinosis is often associated with diseases like chronic renal failure, primary hyperparathyroidism, hypervitaminosis D, milk-alkali syndrome, sarcoidosis and massive osteolysis. [5]

Typical clinical findings, radiology, fine needle aspiration cytology, and histopathology [3] showing calcification help in the diagnosis. Various treatment modalities like aluminium hydroxide or acetazolamide have been tried but none has been found to be effective. Complete surgical excision has been recommended but recurrences are common. [6]

References
1.
Maize J, Metcalf. Metabolic diseases of the skin. In : Elder D, editor. Lever's Histopathology of the skin. 8 th ed. Philadelphia: Lippincott- Raven; 1997. p. 379-82.
th ed. Philadelphia: Lippincott- Raven; 1997. p. 379-82.'>[Google Scholar]
2.
Datta C, Bandyopadhyay D, Bhattacharyya S, Ghosh S. Tumoral calcinosis. Indian J Dermatol Venereol Leprol 2005;71:293.
[Google Scholar]
3.
Lim S, Daruwalla JS, Wee A. Tumoral calcinosis: A case report. Ann Acad Med Singapore 1985;4:391.
[Google Scholar]
4.
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 Clin Endocrinol Metab 1988:67:88.
[Google Scholar]
5.
Smack DP, Norton SA, Fitzpatrick JE. Proposal for a pathogenesis-based classification of tumoral calcinosis. Int J Dermatol 1996;35:265.
[Google Scholar]
6.
Bostrom B. Tumoral calcinosis in an infant. Am J Dis Child 1981;135:246.
[Google Scholar]

Fulltext Views
99

PDF downloads
56
Show Sections