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Two-year follow-up images. X-ray images show third-sixth cervical spine C3-C6 fusion and internal fixation: anteroposterior view (a), lateral view (b). Axial computed tomography scan image demonstrates disappearance of calcified mass in the intervertebral foramen of fourth-fifth cervical spine (c). Coronal computed tomography scan image also demonstrates disappearance of calcified mass at right side of spine (d)
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Background
Tumoral calcinosis is rarely located in spine. A 55-year-old Japanese woman with cervical tumoral calcinosis is presented, along with a review of the literature relating to tumoral calcinosis in the spine. We discussed the etiology, diagnosis, and management of this condition.
Case presentation
We report a case of a patient with cervica...
Context in source publication
Context 1
... and dull pain in the right upper extremity gradually disappeared postoperatively. The muscle strength of the right upper extremity on the manual muscle testing was full recovered. Postopera- tive X-rays (anteroposterior view and lateral view) and CT performed 2 years after surgery demonstrated the disappearance of the residual calcified masses (Fig. 4a, b, c, ...
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Study Design
Retrospective study of 37 consecutive female patients with cervical spondylotic myelopathy who underwent reconstructed computed tomography (CT) scanning of the cervical spine.
Purpose
The purpose of this study was to investigate whether the vertebral lateral notch of the cervical spine is an effective landmark to determine the entry p...
Citations
... It predominantly occurs in the hips, elbows, and shoulders, with only 7% of cases occurring in the spine. 1,2 Spinal tumoral calcinosis can present with pain or neurological deficits due to compressive radiculomyelopathy or may be discovered simply as a growing or painful paravertebral mass. [3][4][5] These lesions can mimic neoplasms on imaging or even gross intraoperative appearance, presenting a diagnostic challenge. ...
... 14 Such procedures aim for resection, decompression of neurovascular structures with laminectomy or facetectomy, and promotion of stability by fusion or arthrodesis. 1,6 Case series imply that incomplete resection may be associated with recurrence risk, with recurrence rates for tumoral calcinosis up to 75% following subtotal resection. 2,12,[26][27][28] While the risk of recurrence is less understood for spinal tumoral calcinosis specifically, in one review of 41 cases, Kalani (Table 1); [9][10][11][12][13][14][29][30][31][32][33][34][35][36] 42.9% (6/14) cases were idiopathic and the most commonly known cause was sclerodermal disease (35.7%). ...
BACKGROUND
Tumoral calcinosis is an uncommon disease resulting from dystrophic calcium phosphate crystal deposition, with only 7% of cases involving the spine, and it may diagnostically mimic neoplasms.
OBSERVATIONS
In this case, a 54-year-old woman with history of systemic scleroderma presented with 10 months of progressive left lumbosacral pain. Imaging revealed an expansile, 4 × 7-cm, well-circumscribed mass in the lumbosacral spine with L5–S1 neuroforaminal compression. Because intractable pain and computed tomography (CT)-guided needle biopsy did not entirely rule out malignancy, operative management was pursued. The patient underwent L4–S2 laminectomies, left L5–S1 facetectomy, L5 and S1 pediculectomies, and en bloc resection, performed under stereotactic CT-guided intraoperative navigation. Subsequently, instrumented fusion was performed with L4 and L5 pedicle screws and S2 alar-iliac screws. Pathological examination was consistent with tumoral calcinosis, with multiple nodules of amorphous basophilic granular calcified material lined by histiocytes. There was no evidence of recurrence or neurological deficits at 5-month follow-up.
LESSONS
Because spinal tumoral calcinosis may mimic neoplasms on imaging or gross intraoperative appearance, awareness of this clinical entity is essential for any spine surgeon. A review of all case reports of lumbosacral tumoral calcinosis (n = 14 from 1952 to 2016) was additionally performed. The case featured in this report presents the first known case of navigation-assisted resection of lumbosacral tumoral calcinosis.
... Uraemic tumoral calcinosis often appears 8-36 months after SHPT onset, with an incidence rate of 0.5-3.0% [6,7], and the actual incidence rate may be higher due to the lack of specific symptoms at the early disease stage. With the advancements in blood purification technologies, the incidence of SHPT is increasing annually, and the incidence of UTC increases accordingly [8]. ...
Few cases of uraemic tumoral calcinosis (UTC) have been reported. This study aimed to investigate the clinical efficacy of parathyroidectomy for UTC. Historical clinical data of patients with end-stage renal disease and UTC who underwent parathyroidectomy were analysed. Absorption of metastatic calcification was compared before and after operation. Changes in intact parathyroid hormone, serum calcium, phosphorus, and alkaline phosphatase levels were analysed before parathyroidectomy and at 1 week and 3, 6, and 12 months after parathyroidectomy. Eight patients met the enrolment criteria (men, 6; mean age, 38.6 SD 10.9 years). Uraemic tumoral calcinosis, which developed 2–8 years after dialysis began, was caused by secondary hyperparathyroidism. Massive calcium deposition was found in the shoulder ( n = 6), hip ( n = 3), and elbow ( n = 2). Four patients had > 2 joints affected, and a single joint was involved for four patients. Seven patients had rapid remission (< 6 months) of the masses after parathyroidectomy. In one patient, the mass remained unabsorbed until 6 months postoperatively. Hypocalcaemia occurred in all patients where parathyroidectomy was successful, and calcium supplementation was required 1 year postoperatively. Serum intact parathyroid hormone levels on day 7 and at 3 and 6 months postoperatively decreased significantly from baseline and remained low 1 year postoperatively (22.015 SD33.134 pg/mL). Postoperative phosphorus levels were significantly lower than preoperative levels ( p < 0.05), but no significant difference was found in alkaline phosphatase levels ( p > 0.05). Parathyroidectomy has promising efficacy for UTC treatment and regulation of serum intact parathyroid hormone and phosphorus. Hypocalcaemia is a common complication after parathyroidectomy. Current Controlled Trials ChiCTR2000041311, date of registration: Dec. 23, 2020.
... The typical gross description is a soft lesion with lobulated calcifications typically found at the joints. Although TC is most often found in the extremities, there are a growing number of cases of calcified tumors due to various etiologies in the spine and even the spinal canal [5][6][7][8][9][10]. Recent reports have noted that the clinical presentation may be subacute or even acute in nature as described by Al Sukaini et al. in a case report and review of five cases in the literature [11]. ...
... Al-Sukaini et al. reported the acute decompensation of a patient with cervical TC and discussed 10 symptomatic and nonsymptomatic reports of TC in the spine of adult patients [11]. The importance of a detailed history is supported by the literature which notes many patients with spinal TC have a history of rheumatologic disease such as Raynaud's, scleroderma, and/or rheumatoid arthritis [13][14][15] while other cohorts demonstrated renal failure and/or hyperparathyroidism [7,[16][17]. ...
Tumoral calcinosis (TC) is an uncommon disease that has been linked to familial genetic mutations but can often be due to secondary causes such as chronic renal failure and hyperparathyroidism. There are rare instances of tumoral calcinosis induced by foreign body injections, often for cosmetic purposes. Here we describe operative management of spinal cord compression due to mineral oil injection induced tumoral calcinosis. A 54-year-old transgender female presented with signs of myelopathy so severe that she had become wheelchair bound. Labs demonstrated hypercalcemia and imaging of the neuroaxis revealed significant calcification resulting in cervicothoracic and lumbar central canal stenosis. Given symptomatic cervical spinal cord compression, she was taken to the OR for urgent laminectomy and decompression. Postoperatively, she recovered well and was ambulating independently by postoperative day (POD) 9. This is the first reported case of localized mineral oil injections causing distant calcification with subsequent symptomatic cord compression requiring operative intervention.
... Tumoral calcinosis is rarely located in the spine. Moreover, thoracic lesions are rarer than cervical and lumbar lesions [6]. Durant et al. reported only 3 cases of thoracic spine among 21 cases of spinal tumoral calcinosis. ...
Tumoral calcinosis involving the spine is rare. The involvement of the thoracic spine is rarer than that of the cervical or lumbar spine. We report a case of thoracic tumoral calcinosis accompanied by vertebral fracture with increased concentrations of inflammatory markers and no abnormalities in serum calcinosis and phosphorus concentration. A 60-year-old woman presented with complete paraplegia. Her white blood cell count and C-reactive protein (CRP) concentration were elevated. The thoracic magnetic resonance imaging revealed vertebral fracture and an epidural mass that demonstrated low intensity on both T2- and T1-weighted images at the T9/10 dorsal side of the central canal. This lesion is larger in size than that observed in the previous 2 months. Her laboratory data showed signs of infection, and only decompression surgery without fixation for treatment and diagnosis was performed. Histopathological examination was consistent with tumoral calcinosis. Postoperatively, the patient's white cell count and CRP concentration were normalized. We found that tumoral calcinosis can occur at the thoracic level on the basis of the spinal instability due to the vertebral compression fracture and the accompanying increase in inflammation indicated by increased white blood cell count and CRP concentration.
... Regarding TC of the spine, a literature search revealed 15 cases of TC involving the cervical spine, not including this case, in addition to three involving the thoracic spine and 14 involving the lumbar spine. 9 Of note, the youngest reported case of TC involving the spine was found to be 1.4 years of age, 10 making this case possibly the youngest instance of a spinal primary TC reported in literature at 4 months of age. ...
Tumoral calcinosis (TC) is an exceedingly rare disease, significantly so when located in the spine. Here, we present a 4-month-old patient with decreased head control and range of motion of the neck for several weeks. CT and MRI demonstrated a calcified mass in the retropharyngeal area and surrounding C1/C2, and TC was suspected. The patient underwent surgical biopsy and aspiration, which confirmed TC. The purpose of this case report is to document a rare disease, significantly so when taking into account both the location of the lesion and the patient's age, and to detail the treatment and response.
... 5 Tumoral calcinosis is usually located next to large joints but can also appear in association to the spine. 6 Furthermore, PET/CT demonstrated the previously unknown high inflammatory activity of the calcifying processes. In the absence of another plausible pathological finding, the tumoral calcinosis was deemed to be the cause of the fever. ...
Unexpected inflammatory activity of tumoral calcinosis periarticular to the shoulders and hips in a man with recurrent fever of unknown origin and dialysis-dependent kidney insufficiency was revealed by FDG PET/CT. In absence of other pathologies, the calcinosis was deemed to be the cause of the fever. An infectious or malignant disease could be ruled out, so further therapeutic steps were enabled.
... In general, the most affected joints are the hips, shoulders and occasionally the spine. In small joints and the skin, painful masses can be identified [2]. ...
Soft-tissue calcifications in the head and neck are relatively common and are the result of a wide variety of benign and malignant pathologies. They can present a diagnostic challenge given the broad range of underlying etiologies. Uremic tumoral calcinosis (UTC) is a rare complication of end-stage renal disease (ESRD) resulting from metastatic soft tissue calcification. Common sites include periarticular soft tissues of the shoulders, elbows, and hands (Pan and Chen, 2016). UTC can also affect the cervical spine and mimic osteosarcomas (Zhou et al., 2018). We present the case of a 71-year-old female with hypertension, left carotid artery stenosis, mitral valve prolapse, and ESRD secondary to diabetes mellitus type II (DMII) on peritoneal dialysis who was found to have large, heterogeneous, bilateral calcified neck masses. Given her clinical history, laboratory results, and imaging findings, she was diagnosed with UTC. In addition to this case, we provide an overview of tumoral calcinosis (TC) and a differential diagnosis for calcified lesions of the head and neck.
Tumoral calcinosis (TC) refers to calcium salt deposition around large joints. It rarely affects the temporomandibular joint (TMJ), and only eight cases have been reported to date. We describe a case of TC in the left TMJ with resorption of the condyle and mandibular fossa. A 37-year-old woman complaining of malocclusion and a painless swelling around the left TMJ was referred to our hospital. The patient's medical history included Sjogren's syndrome and systemic sclerosis. Computed tomography and magnetic resonance imaging revealed calcification with a maximum diameter of 25 mm and resorption of the condyle and mandibular fossa. A clinical diagnosis of tophaceous pseudogout was made on the basis of these findings. The calcification was removed, and the TMJ was reconstructed under general anesthesia using a total TMJ replacement system. Pathological examination revealed TC. The patient was considered to have secondary TC based on the patient's medical history and results of additional blood tests. At six months post-operation, the patient had stable occlusion without TC recurrence.
