Journal of Cytology
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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 25  |  Issue : 1  |  Page : 23-24
Idiopathic calcinosis of scrotum: Cytological diagnosis of a case


1 Department of Pathology, JN Medical College, AMU, Aligarh, India
2 Department of Surgery, JN Medical College, AMU, Aligarh, India

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   Abstract 

A 35 year-old male presented with multiple asymptomatic, tense, cystic to firm, skin-colored nodules within the scrotal skin with a provisional clinical diagnosis of a sebaceous cysts of the scrotum. Fine needle aspiration cytology (FNAC) was performed and a diagnosis of idiopathic calcinosis of the scrotum was suggested as no epithelial cells were found around amorphous, basophilic, calcified material. Histopathological examination confirmed the diagnosis. We report this case for its rarity.

Keywords: Idiopathic calcinosis; scrotum.

How to cite this article:
Sherwani RK, Varshney BK, Maheshwari V, Rahman K, Khan M A. Idiopathic calcinosis of scrotum: Cytological diagnosis of a case. J Cytol 2008;25:23-4

How to cite this URL:
Sherwani RK, Varshney BK, Maheshwari V, Rahman K, Khan M A. Idiopathic calcinosis of scrotum: Cytological diagnosis of a case. J Cytol [serial online] 2008 [cited 2014 Jul 22];25:23-4. Available from: http://www.jcytol.org/text.asp?2008/25/1/23/40654



   Introduction Top


Idiopathic calcinosis of the scrotum is a rare and benign condition defined as the existence of multiple calcified and asymptomatic nodules within the scrotal skin that occur without any anomaly of calcium or phosphorus metabolism.


   Case Report Top


A 35 year-old male presented with multiple, painless, tense, cystic to firm nodules within the scrotal skin for the last one year with a history of occasional discharge of a whitish chalky material. There was no preceding history of trauma, inflammation, or any other scrotal disease. Cutaneous examination revealed multiple, firm, painless, skin-colored nodules within the scrotal skin, 1-3 cm in size [Figure - 1]. The external genitalia and groin did not reveal any abnormality. Serum and urinary levels of calcium and phosphate were normal. The appearance of tense cystic to firm, uniformly outlined scrotal nodules led to the provisional clinical diagnosis of sebaceous cysts of the scrotum. Hematoxylin and Eosin (H and E)-stained FNA smears from these scrotal nodules showed amorphous, basophilic masses, granules, and debris of calcium [Figure - 2], which was confirmed by von Kossa stain. No epithelial cells were found, hence, a cytological diagnosis of idiopathic calcinosis of the scrotum was suggested. En bloc surgical excision was performed. Histopathological examination showed amorphous, basophilic deposits of calcium in the dermis surrounded by histiocytes and an inflammatory giant cell reaction [Figure - 3]. No cellular structures were noted. Histopathology confirmed the diagnosis of idiopathic calcinosis of the scrotum. No recurrence was observed after a six months' follow-up period.


   Discussion Top


Idiopathic calcinosis of the scrotum is a rare and benign condition described initially by Lewinski in 1883. [1] The condition is characterized by multiple calcified and asymptomatic nodules within the scrotal skin that usually occurs during childhood or early adulthood. Occasionally, the nodules may discharge a chalky material. [2] Histologically, idiopathic calcinosis of the scrotum is characterized by amorphous, basophilic, calcium deposits within the dermis that are variable in size, often surrounded by a foreign body type of granulomatous reaction. [3]

The pathogenesis of scrotal calcinosis is still controversial. Some authors are of the view that scrotal calcinosis is the result of dystrophic calcification of preexisting structures such as epidermal, pilar, and ductal cysts while others could not find any evidence of preexisting cystic structures and labeled the condition as idiopathic. [4]

From their study on 51 scrotal nodules, Song et al. , [5] opine that scrotal calcinosis results from dystrophic calcification of scrotal cysts. King et al. , [6] stressed the possible role of dystrophic calcification of dartos muscles. However, Fuzesi et al. , [7] did not find any cellular structure in the calcified nodules and concluded that idiopathic calcinosis of the scrotum is a degenerative phenomenon resulting from alteration in the chemical microenvironment leading to the deposit of calcium and phosphate. Even Wright et al. , [8] who examined 63 lesions in nine patients failed to find any epithelial material around calcified nodules even after staining with the antikeratin monoclonal antibodies, LP34 and PKK1. Similarly, Husain et al. , [9] have asserted the idiopathic nature of scrotal calcinosis in their report on four cases.

However, in the only study on the cytological features of idiopathic scrotal calcinosis published till date, Shivkumar et al. , [10] assert the presence of intense basophilic amorphous granular material surrounded by lymphocytes, histiocytes, and foreign body giant cells without any evidence of epithelial cells in FNA smears. But the role of FNAC remains largely unexplored. It is imperative to examine the excisional biopsy piece histologically because definitive diagnosis rests on it. Treatment of idiopathic calcinosis of the scrotum is limited to surgical excision of the afflicted part of the scrotal wall. In our patient, the result of surgical treatment was satisfactory and no recurrence was observed after a six months' follow-up period.

 
   References Top

1.Lewinski HM. Lymangioma der Haunt mit verkalktem Inhalt. Virchow Arch Pathol Anat 1883;91:371-4.  Back to cited text no. 1    
2.Rosai J, editor. Rosai and Ackerman's surgical pathology. India: Reed Elseiver; 2005.  Back to cited text no. 2    
3.Hicheri J, Badri T, Fazaa B, Zermani R, Kourda N, Jilani SB, et al. Scrotal calcinosis: pathogenesis and case report. Acta Dermatovenerol Alp Panonica Adriat 2005;14:53-6.  Back to cited text no. 3    
4.Pabaηηu φπlii U, Canda MS, Güray M, Kefi A, Canda E. The possible role of dartoic muscle degeneration in the pathogenesis of idiopathic scrotal calcinosis. Br J Dermatol 2003;148:827-9.  Back to cited text no. 4    
5.Song DH, Lee KH, Kang WH. Idiopathic calcinosis of the scrotum: histopathologic observation of 51 nodules. J Am Acad Dermatol 1988;19:1095-101.  Back to cited text no. 5    
6.King DT, Brosman S, Hirose FM, Gillespie LM. Idiopathic calcinosis of the scrotum. Urology 1979;14:92-4.  Back to cited text no. 6    
7.Fuzesi L, Hollweg G, Lagrange W, Mittermayer C. Idiopathic calcinosis of the scrotum: scanning electron microscopic study with X-ray microanalysis. Ultrastruct Pathol 1991;15:167-73.  Back to cited text no. 7    
8.Wright S, Navasaria H, Leigh IM. Idiopathic calcinosis of the scrotum is idiopathic. J Am Acad Dermatol 1991;24:727-30.  Back to cited text no. 8    
9.Husain Y, Hassan RA. Idiopathic scrotal calcinosis: a report of four cases and review of the literature. Int J Dermatol 2005;44:206-9.  Back to cited text no. 9    
10.Shivkumar VB, Gangane N, Kishore S, Sharma S. Cytological features of idiopathic scrotal calcinosis. Acta Cytol 2003;47:110-1.  Back to cited text no. 10    

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Correspondence Address:
Rana K Sherwani
Gul-E-Rana, Nagla Road, Dodhpur, Aligarh - 202 002, Uttar Pradesh
India
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DOI: 10.4103/0970-9371.40654

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