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Age / Sex : 43 / M
Chief complaint : increasing lower back mass (onset 2YA)
PMHx. : HTN (+), ESRD on hemodialysis
What is your diagnosis?
Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer)
Courtesy : 이영준(Eugene Lee), 분당서울대병원(Seoul National University Bundang Hospital)
Diagnosis: Tumoral Calcinosis or Tumoral calcinosis-like metastatic calcification
Discussion
Disease definition
- radiodense periarticular masses caused by dystrophic calcification in soft tissue
- painless, firm, tumor-like masses around the joints that may lead to joint function
limitation specially when the large size
- m/c involvement site: periarticular upper limb (shoulder, elbow), hip regions, spine,
temporomandibular joint, metacarpals, popliteal space
- Cause : complication of renal dialysis, familial (befor age 20)
Findings
1) Plain radiograph
Tumoral calcinosis has a typical appearance on plain radiographs with amorphous and multi-lobulated ("cloud-like") calcification
located in a periarticular distribution.
2) CT
CT better delineates the calcific mass
there is no erosion or osseous destruction by the adjacent soft-tissue masses which is another distinguishing finding of tumoral
calcinosis from other pathologies or tumor
it may show cystic appearance with multiple fluid-calcium levels caused by calcium layering (Sedimentation sign)
3) MRI
These lesions typically demonstrate T1 hypointense signal on MRI.
There is variable T2 signal, which may be hypo- or hyperintense despite the high amount of calcium.
References
1) Tumoral Calcinosis: Pearls, Polemics, and Alternative Possibilities (2006)
Radiographics 26(3):871-85, DOI:10.1148/rg.263055099
2) Review of tumoral calcinosis: A rare clinico-pathological entity (2014)
World J Clin Cases, 16; 2(9): 409–414, doi: 10.12998/wjcc.v2.i9.409
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