Phosphoglyceride crystal deposition disease in the spine: a case report

Phosphoglyceride Crystal Deposition Disease of the Scapula: A Case Report and Literature Review

CASE

A 76-year-old woman presented with a 2-month history of right shoulder pain with no apparent cause. Radiography revealed an ill-defined osteolytic lesion in the right scapular spine with a pathological fracture. Malignant bone tumor was suspected, and a biopsy was performed. Pathological examination with gold hydroxamic acid staining revealed phosphoglyceride crystal deposition. Lesion curettage was performed, and her symptoms improved. No recurrence was observed at the 3-year postoperative follow-up.

CONCLUSION

Phosphoglyceride crystal deposition in the bone is an extremely rare disease. The gold hydroxamic acid staining method might be useful for the diagnosis of this condition.

Phosphoglyceride crystal deposition disease involving adnexa uteri: a case report with histogenetic consideration

We present a rare case of phosphoglyceride crystal deposition disease (PCDD), as a gynecologic disease, with reference to histogenesis of crystal deposition. An 84-year-old woman, who had undergone simple hysterectomy for uterine leiomyoma 44 years previously, presented with multiple masses in the bilateral adnexa and the pelvic wall. The bilateral adnexal tumors were resected. The masses histologically revealed a foreign-body granuloma composed of numerous tiny, radially arranged needle-like crystal lumps surrounded by multinucleated giant cells and macrophages. The crystals showed birefringence under polarized light and were positive for gold hydroxamic acid stain, and the tumor was thus diagnosed as PCDD. The masses revealed central cystic changes due to old hemorrhage, which contained crystal lumps without foreign-body reaction or birefringence. The present case demonstrated for the first time that phosphoglyceride crystals developed in old hemorrhagic foci, although it was not confirmed whether the old hemorrhagic foci were formed after hysterectomy or due to endometriosis.

Phosphoglyceride crystal deposition disease in the abdominal wall: a case report

Background

Phosphoglyceride crystal deposition disease (PGDD) is characterized by phosphoglyceride crystal deposition that simulates neoplasia in soft tissue scars or bone. Reports of PGDDs are rare. Here, we present the case of a patient with PGDD in the abdominal wall.

Case presentation

A 57-year-old Japanese man with worsening right lower abdominal pain had no significant family or occupational history. Laboratory data showed elevated inflammatory markers with a white blood cell count of 14,400 × 10⁹/L and C-reactive protein of 11.8 mg/L, but no other abnormalities. Helical computed tomography (CT) revealed a tumor in the abdominal wall (longest dimension, approximately 10 cm). Positron emission tomography–CT revealed fluorodeoxyglucose accumulation in the mass only (SUVmax, 41). Clinical and radiographic findings suggested malignant lymphoma, undifferentiated sarcoma, or liposarcoma. He underwent exploratory laparotomy and further treatment. At surgery, we found a huge milky-whitish mass with a rough surface in the transversus abdominis. Complete resection was performed and his postoperative recovery was good. Surprisingly, the final pathologic diagnosis was phosphoglyceride crystal deposition disease with the characteristic crystal deposition in a corolla shape, histiocytic reaction with abundant foreign-body-type giant cells, and no evidence of neoplasia. The patient remains asymptomatic with no disease recurrence.

Conclusion

Although phosphoglyceride crystal deposition disease in the abdominal wall is rarely encountered in clinical practice, its inclusion in differential diagnosis is important. Given the occurrence at sites of invasive procedures, we believe efforts to reduce invasiveness when performing surgery and follow-up for early detection of recurrence are important.

Phosphoglyceride crystal deposition disease mimicking a malignant tumor

A 45-year-old woman who had undergone surgical repair for an atrial septal defect at the age of 7 years presented with multiple anterior mediastinal masses. Positron-emission tomography (PET) with 2-[¹⁸F]fluoro-2-deoxy-d-glucose (FDG) revealed high uptake in the masses. The findings were interpreted as mediastinal malignant tumors with dissemination. Biopsy was performed, and the histological diagnosis was phosphoglyceride crystal deposition disease without neoplastic changes. Although phosphoglyceride crystal deposition disease is rare, it should be recognized as a potential interpretive pitfall that mimics a malignant tumor in FDG-PET findings in a patient after cardiac surgery.

A case of phosphoglyceride crystal deposition disease in the pelvic soft tissues recurring after initial surgery

Phosphoglyceride crystal deposition disease (PGDD) is a rare disease entity that is characterized by phosphoglyceride crystal deposition that stimulates the formation of masses in soft tissue scars or bones. We report a case of PGDD in the pelvic soft tissues that recurred after initial surgical treatment. A 50-year-old woman was referred to our hospital for the evaluation of pelvic masses that were observed on an abdominal ultrasound. Magnetic resonance imaging (MRI) revealed masses in the pelvic region, with the largest being 10 cm in diameter. The masses were diagnosed as ovarian malignant tumors, and an exploratory laparotomy was performed. Operative findings revealed them to be foreign body granulomas, and the patient was diagnosed with PGDD. The patient had a history of cesarean delivery at the age of 24 years. PGDD is extremely rare, but it should be considered in the differential diagnosis of abdominal masses in patients with a history of abdominal surgery.