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Andriandi, Husnul F, Tirta C. Tumoral calcinosis in chronic renal failure: A case report and literature review. Int J Surg Case Rep 2024; 123:110237. [PMID: 39288483 PMCID: PMC11420456 DOI: 10.1016/j.ijscr.2024.110237] [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: 05/15/2024] [Revised: 08/22/2024] [Accepted: 08/31/2024] [Indexed: 09/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Tumor calcinosis is a rare and benign disorder characterized by calcified periarticular soft tissue masses. It may be idiopathic or caused by a condition known as hyperphosphatemia. There is still no definitive guideline for treating this disease, with excision being one of the primary treatment modalities. CASE PRESENTATION 2 patients with a history of longstanding diabetes and dialysis presented with a painless lump on their right buttock, measuring 18 × 30 cm in the right gluteal region. Laboratory examinations showed a high ureum, creatinine, and serum phosphate. A radiograph revealed opacity on the right hip joint, without involvement of the proximal femur bone. A biopsy confirmed the diagnosis of tumor calcinosis. Both patients were treated with calcium carbonate to control their high serum phosphate levels. Both patients showed excellent tumor control without progression. CLINICAL DISCUSSION Tumoral calcinosis (TC) is an extra-articular benign but aggressive tumor. The precise mechanism of TC remains unknown, which partly explains the lack of established treatment modality. We treat our patients with calcium carbonate to reduce the serum phosphate and treat the tumor without surgery. The treatment yielded a satisfactory clinical result. CONCLUSION This study showed that a secondary TC may be conservatively treated without any surgical excision if we address the underlying problem. But it may not result in a reduction of the tumor's size.
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Affiliation(s)
- Andriandi
- Orthopaedic and Traumatology Department, Faculty of Medicine, Universitas Sumatera Utara/Haji Adam Malik General Hospital, Medan, Indonesia
| | - F Husnul
- Orthopaedic and Traumatology Department, Faculty of Medicine, Universitas Sumatera Utara/Haji Adam Malik General Hospital, Medan, Indonesia
| | - C Tirta
- Orthopaedic and Traumatology Department, Faculty of Medicine, Universitas Sumatera Utara/Haji Adam Malik General Hospital, Medan, Indonesia.
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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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Zhang R, Li G, Yang L, Li Y, Ou J, Zhang D, Chen T, Feng S. Multiple ectopic calcifications in subcutaneous tissues with chronic renal failure: A case report. Int J Surg Case Rep 2016; 29:113-119. [PMID: 27838530 PMCID: PMC5109727 DOI: 10.1016/j.ijscr.2016.09.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- RongKai Zhang
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, China
| | - GuoWei Li
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, China
| | - LuKun Yang
- Department of Anesthesiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, China
| | - YingQin Li
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, China
| | - Jinghuan Ou
- Department of Allocation, Kaiping Central Hospital, Kaiping, 529300, China
| | - DaWei Zhang
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, China
| | - Tao Chen
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, China
| | - Shaoyan Feng
- Department of Otolaryngology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, China.
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