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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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Gonte MR, Brooks C, Klomparens K, Greenberg Y, Janevski P. Surgical Management of Tumoral Calcinosis of the Hand: A Case Report. J Hand Microsurg 2024; 16:100046. [PMID: 38855518 PMCID: PMC11144637 DOI: 10.1055/s-0043-1771230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Primary tumoral calcinosis is a rare and benign condition characterized by calcium salt deposition in periarticular soft tissues. It typically presents as a firm, rubbery mass that arises around large joints. While an estimated 250 cases have been described since its discovery, very few cases have been identified in the hand. We present a case of multiple calcified masses in the hand, one of which required meticulous dissection from a digital neurovascular bundle, and our technique for surgical excision. We present this case to lower the threshold for clinical suspicion of tumoral calcinosis for patients who present with a soft tissue mass in the hand. Furthermore, we recommend prompt surgical excision due to low success rates of alternative treatment options and to prevent potential neurovasculature or tendon injury.
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Affiliation(s)
- Madeleine R. Gonte
- Department of Plastic Surgery, Henry Ford Hospital, Detroit, Michigan, United States
- Wayne State University School of Medicine, Detroit, Michigan, United States
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Collin Brooks
- Department of Plastic Surgery, Henry Ford Hospital, Detroit, Michigan, United States
- Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Kara Klomparens
- Department of Plastic Surgery, Henry Ford Hospital, Detroit, Michigan, United States
- Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Yitzchok Greenberg
- Department of Plastic Surgery, Henry Ford Hospital, Detroit, Michigan, United States
| | - Peter Janevski
- Department of Plastic Surgery, Henry Ford Hospital, Detroit, Michigan, United States
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AlShamsi M, AlDhamin A. Tumoral calcinosis in the extensor indicis proprius tendon: A case report. Clin Case Rep 2023; 11:e7541. [PMID: 37397572 PMCID: PMC10307994 DOI: 10.1002/ccr3.7541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/09/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Tumoral calcinosis is a rare clinicopathological entity characterized by the presence of calcified deposits in the periarticular soft tissue. Commonly affecting the hips, buttock, shoulders, and elbow, and less commonly in hands, wrists, and feet. We present a novel case of tumoral calcinosis in a 4-year-old female with an atraumatic wrist swelling for 2 months. It was a diagnostic enigma for the surgeon due to the peculiar site of presentation. However, with the help of a pathologist, we diagnosed and successfully treated tumoral calcinosis of the extensor indicis proprius tendon.
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Extensive Tumoral Calcinosis of the Hand. J Hand Surg Am 2021; 46:1031.e1-1031.e6. [PMID: 33375992 DOI: 10.1016/j.jhsa.2020.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/26/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
Tumoral calcinosis is a rare and benign subtype of calcinosis cutis, a group of disorders involving soft tissue calcium deposition. Only 250 cases have been described since 1898; hand involvement is exceedingly rare. We report a case of extensive calcinosis within the flexor sheath of the little finger. Presentation included a painful mass over the volar aspect of the little finger, restricted digit motion, and skin compromise at the site of the mass. Surgical debulking was performed resulting in restoration of finger function.
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Heterotopic ossification: radiological and pathological review. Radiol Oncol 2019; 53:275-284. [PMID: 31553710 PMCID: PMC6765162 DOI: 10.2478/raon-2019-0039] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023] Open
Abstract
Background Heterotopic Ossification (HO) is a common condition referring to ectopic bone formation in soft tissues. It has two major etiologies, acquired (more common) and genetic. The acquired form is closely related to tissue trauma. The exact pathogenesis of this disease remains unclear; however, there is ongoing research in prophylactic and therapeutic treatments that is promising. Conclusions Due to HO potential to cause disability, it is so important to differentiate it from other causes in order to establish the best possible management.
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Sherman CE, Murray PM. Tumor-Like Conditions of the Hand and Upper Extremity. J Hand Surg Am 2017; 42:1009-1017. [PMID: 29089162 DOI: 10.1016/j.jhsa.2017.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/18/2017] [Indexed: 02/02/2023]
Abstract
Tumor-like conditions of the hand and upper extremity typically present as masses and can be confused as more serious conditions. The differential diagnosis of these lesions can cross over with many more commonly recognized benign and malignant upper limb tumors, and it is, therefore, important for the hand surgeon to be familiar with tumor-like conditions. The diagnosis of these lesions often can be made on clinical grounds supported by a careful physical examination and plain film radiography. Advanced imaging and excisional biopsy may be needed in many circumstances to secure the diagnosis given their similarity with bone and soft tissue sarcomas.
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Affiliation(s)
| | - Peter M Murray
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL.
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A Rare Case of Tumoral Calcium Pyrophosphate Dihydrate Crystal Deposition Disease of the Wrist Joint. Case Rep Orthop 2016; 2015:313291. [PMID: 26783477 PMCID: PMC4691467 DOI: 10.1155/2015/313291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/09/2015] [Indexed: 12/29/2022] Open
Abstract
Introduction. Tumoral calcium pyrophosphate dihydrate (CPPD) crystal deposition disease (CPPDCD), also known as tophaceous calcium pyrophosphate deposition disease (CPDD), is a tumorlike lesion, and it should be distinguished from usual CPDD that causes severe joint inflammation and arthralgia. A case of tumoral CPPDCD of the wrist joint that required differentiation from synovial osteochondromatosis is described. Case Presentation. The patient was a 78-year-old woman with a 5-year history of nodular lesions at the right wrist that had gradually increased in size. An excisional biopsy and a histological examination of the excised nodular lesions by hematoxylin and eosin (H&E) staining were performed, demonstrating numerous polarizable, rhabdoid, and rectangular crystals, surrounded by fibroblasts, macrophages, and foreign body-type giant cells, consistent with tumoral CPPDCD. Conclusion. Tumoral CPPDCD, especially at the wrist joint, is rare, and, to the best of our knowledge, only 2 articles have been published. This case seems to need further follow-up for recurrence, because tumoral CPPDCD may recur after complete or incomplete surgical excision.
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Abstract
Calcium, or calcific, deposition disease in the form of acute calcific periarthritis of the hand and wrist is an uncommon entity that may be confused with more common crystalline or inflammatory arthropathies as well as infection. It is important for the clinician to be aware of this disease process and to include it in the differential diagnosis of patients presenting with acutely painful, focal inflammation of the hand or wrist. Nonsurgical management is often sufficient; however, considering the self-limited nature of the disease, accurate diagnosis is essential to avoid unnecessary antibiotic or surgical treatment.
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Hutt N, Baghla DP, Gulati V, Pastides PS, Beverly MC, Bashir WA. Acral post-traumatic tumoral calcinosis in pregnancy: a case report. J Med Case Rep 2011; 5:89. [PMID: 21366915 PMCID: PMC3056806 DOI: 10.1186/1752-1947-5-89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 03/02/2011] [Indexed: 11/16/2022] Open
Abstract
Introduction Tumoral calcinosis is an uncommon disorder characterized by the development of calcified masses within the peri-articular soft tissues of large joints, but rarely occurs within the hand. Case presentation We present the case of a 31-year-old pregnant Indian woman with a three-month history of painful swelling within the tip of her right middle finger following a superficial laceration. She was otherwise well and had normal serum calcium and phosphate levels. Plain radiography demonstrated a dense, lobulated cluster of calcified nodules within the soft tissues of the volar pulp space, consistent with a diagnosis of tumoral calcinosis. This diagnosis was confirmed on the basis of the histopathological examination following surgical excision. Conclusion To the best of our knowledge, we present the only reported case of acral tumoral calcinosis within the finger, and the first description of its occurrence during pregnancy. We review the etiology, pathogenesis and treatment of tumoral calcinosis.
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Affiliation(s)
- Nick Hutt
- Department of Orthopaedic Surgery, Ealing Hospital NHS Trust, Uxbridge Road, Southall, UB1 3HW, UK.
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Abstract
Tumoral calcinosis is an uncommon lesion, composed of ectopic calcified tissue, most commonly seen in the large joints of the hips, shoulders, and elbows, but may involve the hand and wrist. Patients will often present with localized swelling and reduced mobility around the involved joints. Pain is inconsistent when presenting in the hands or wrists, but the lesions may interfere with daily activities. Multiple variations of the process have been described, ranging from those with no definable etiology (primary), to those associated with disorders (secondary) such as renal insufficiency, hyperparathyroidism, or hypervitaminosis D. The original description of tumoral calcinosis, however, is the familial or hereditary type. Treatment of this process involves optimizing the underlying physiology and complete surgical excision for symptomatic cases.
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Laskin WB, Miettinen M, Fetsch JF. Calcareous Lesions of the Distal Extremities Resembling Tumoral Calcinosis (Tumoral Calcinosislike Lesions): Clinicopathologic Study of 43 Cases Emphasizing a Pathogenesis-based Approach to Classification. Am J Surg Pathol 2007; 31:15-25. [PMID: 17197915 DOI: 10.1097/01.pas.0000213321.12542.eb] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Herein, we analyze the clinicopathologic features of 46 distal extremity lesions that have histologic features similar to conventional tumoral calcinosis (tumoral calcinosislike; TC-L). The study included 31 females and 12 males (whites:non-whites>3:1) ranging in age from 1 to 91 (mean, 39; median, 42) years. The lesions presented in fingers (n=20), feet (n=10), wrist (n=6), hands (5), toes (n=4), and ankle (n=1) were solitary in all but 5 patients and ranged in size from 0.3 to 4.5 (mean, 1.6; median, 1.4) cm. Chief initial complaints included presence of a painful (n=16) or asymptomatic (n=7) mass, and limitation of joint mobility (n=3). Pertinent clinical associations included antecedent trauma (n=7), scleroderma (n=3), long-standing osteoarthritis (n=3), bony deformities (n=5), including 2 infants with congenital hand malformations, and chronic renal failure (n=2). Patients were stratified into one of the 3 recognized clinical settings of TC: primary normophosphatemic (n=17), secondary (n=5), or primary hyperphosphatemic TC (n=1). The 20 remaining patients were placed in an "indeterminate TC" category. Most lesions were located in tenosynovial/fascial tissue, but 13 lesions involved dermis and 1 was intra-articular. Histologically, the process consisted of multiple cystic or cleftlike spaces bordered by histiocytes, osteoclastlike giant cells, and a variable inflammatory infiltrate and containing fibrin, granular calcific debris, and calcospherites. Pools of calcific debris bordered by sclerotic collagen and a sparse cellular element predominated in 4 cases. Cartilaginous metaplasia was identified in 10 lesions and evidence of hemorrhage or specific injury was observed in 12 examples. Follow-up data for 22 patients (interval range, 1 to 30 y; median, 6 y) revealed 17 individuals with no evidence of recurrent disease or the development of additional lesions after simple (local) excision. One patient (indeterminate TC) required reexcision of a thumb mass 1 year after surgery. All 3 scleroderma patients developed additional TC-L lesions. Acral TC-L lesions are histologically similar to conventional TC, but present as smaller size lesions. Most TC-L lesions are closely aligned with primary normophosphatemic or secondary TC. Acral TC-L lesions may be the first manifestation of scleroderma, where the process has the potential to follow an unrelenting course.
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Affiliation(s)
- William B Laskin
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Northwestern Memorial Hospital, 251 East Huron Street, Chicago, IL 60611, USA.
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