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Age / Sex : 71 / F
Chief complaint : right palm mass since 6years ago, enlarged mass
during 1 year
What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)
Courtesy: Hye Won Chung, Asan Medical Center
Diagnosis: CPPD crystal deposition disease (tumoral pseudogout)
Discussion
Findings: A 2.1 x 1.5 x 1.9cm
sized, well-defined, lobulating-contoured, soft tissue lesion in palmar aspect
of 3rd and 4th MCP joint region.
- with
diffuse dense calcification
- extension
and abutment of the lesion with the joint capsule at the radial side 4th MCP
joint.
- No
associated adjacent bone abnormality.
Differential Diagnosis:
1) CPPD crystal deposition disease
2) Tophaceous gout
3) Parosteal chondroma.
4) Tumoral calcinosis.
5) BPOP
6) Calcified aponeurotic fibroma.
Diagnosis: CPPD crystal deposition disease (Tumoral pseudogout)
Discussion:
•
Tumoral pseudogout:
–
rarest form of CPPD
crystal deposition disease
–
appears to contain
CPPD crystals that form a tumor-like mass in an extra-articular location
–
monoarticular >
polyarticular
–
female, middle-aged
~ older
–
TMJ > MCP >
MTP joints
–
easily mistaken for
other entities such as chondroid tumors
•
Radiograph
–
radio-opaque
soft-tissue mass with varying internal calcific densities / granular and fluffy
pattern around a joint
–
occasionally with
pressure erosion on the adjacent bones
•
CT
–
soft-tissue mass
with homogeneously distributed amorphous calcification, lobulation, and
septation
•
MR: various
–
T1-WI : low or iso
SI to muscle
–
T2-WI: uniform high
SI ~ heterogeneous, intermediate SI with or without internal higher or lower
signal foci
–
single or multiple
foci of dark SI foci on both T1- and T2-WI
–
Enhancement:
peripheral or diffuse with or w/o focal, non-enhanced area
References:
1. Coombs
RJ, Padanilam TG, Phillips E. Tumoral pseudogout of the metatarsal. Skeletal
Radiol. 2002; 31(1):39-42.
2. Bahk
WJ, Chang ED, Lee AH, Kang YK, Park JM, Chung YG. Huge tophaceous pseudogout
associated with tenosynovial chondromatosis arising from flexor digitorum
tendon sheaths of the foot: a case report. Skeletal Radiol. 2013;
42(12):1755-1759.
3. Park HJ,
CHUNG HW, Oh TS, Lee J-S, Song JE, Park Y-K. Tumoral pseudogout of the proximal
interphalangeal joint of a finger: a case report and literature review.
Skeletal Radiol 2016 Apr 6 [Epub ahead of print]
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