Cytodiagnosis of tumoral calcinosis

Subhashish Das; R Kalyani; ML Harendra Kumar

doi:10.4103/0970-9371.50806

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LETTER TO EDITOR

Year : 2008 | Volume : 25 | Issue : 4 | Page : 160-161

Cytodiagnosis of tumoral calcinosis

Subhashish Das, R Kalyani, ML Harendra Kumar
Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, India

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How to cite this article:
Das S, Kalyani R, Harendra Kumar M L. Cytodiagnosis of tumoral calcinosis. J Cytol 2008;25:160-1

How to cite this URL:
Das S, Kalyani R, Harendra Kumar M L. Cytodiagnosis of tumoral calcinosis. J Cytol [serial online] 2008 [cited 2023 Mar 23];25:160-1. Available from: https://www.jcytol.org/text.asp?2008/25/4/160/50806

Sir,

Tumoral calcinosis is a rare clinico-pathological entity that is distinct from other calcific lesions such as the milk-alkali syndrome, hypervitaminosis-D myositis ossificans, and hyperparathyroidism associated with chronic renal failure.

A 45 year-old male presented with a firm, irregular, painless, soft tissue mass of six months' duration, measuring 3 × 2 cm around the elbow joint, with normal overlying skin. The lesion remained localised without the involvement of any adjoining structures; there was no history of trauma. General and systemic examination results were normal. A clinical diagnosis of a parasitic lesion was considered along with the possibilities of a skin adenexal tumor, schwannoma, neurofibroma, and lipoma. Blood eosinophil and absolute eosinophil counts (AEC), and serum calcium and phosphorus levels were normal. Radiograph showed features of an osseous, lytic lesion. Fine needle aspiration cytology (FNAC) was performed using a 22 gauge needle and a 10 mL disposable syringe to aspirate grey-white granular material for the preparation of smears. The smears were fixed in 95% alcohol and stained with hematoxylin and eosin (H and E), whereas the air-dried smears were stained with May-Grünwald-Giemsa (MGG) stain. Microscopy showed clumps of intense, basophilic, amorphous calcium deposits [Figure 1] along with few ill-defined granulomas in the background. A diagnosis of tumoral calcinosis was rendered and surgical excision was done. On gross examination, the lesion was found to be firm, irregular, and 3 × 2 cm in size. The cut section was gritty and showed whitish, chalky areas of calcification. Multiple sections were taken and stained with H and E and von Kossa stain. Microscopy showed the accumulation of calcium deposits without any necrosis or collection of eosinophils or lymphocytes [Figure 2] and no evidence of dead or living parasites. The sections stained with von Kossa stain were strongly positive [[Figure 2] inset]. Histological staging was done as per the criteria suggested by Thomson et al. [1] and Veress et al. [2] and a final diagnosis of stage I tumoral calcinosis was made.

Tumoral calcinosis is a variant of idiopathic calcinosis cutis and consists of numerous, large, painless, calcified subcutaneous masses in juxta-articular sites, particularly around the hip, shoulders, and elbows. Occasional cases have been reported in the distal femur and neck and multiple, concurrent, or asynchronous lesions have been reported.^[3] There is no sex preponderance, but it shows a familial tendency.

Shivkumar et al .^[4] studied the cytological features of idiopathic scrotal calcinosis and noted the presence of intense, basophilic, amorphous, granular deposits surrounded by lymphocytes, histiocytes, and foreign body giant cells without any evidence of epithelial cells in the smears. Recent studies have shown that tumoral calcinosis is a form of dystrophic calcification related to mechanical trauma or injury.^[5] This theory is favored by the fact that the distribution of the lesions occurs predominantly in pressure points, and in the rural population whose poor socio-economic conditions mean that they sleep on the ground or on a wooden board or a hard floor, which in turn, damages the collagen, possibly by pressure ischemia and ultimately, leads to calcification and the formation of tumoral calcinosis.^[5]

A thorough knowledge of this entity will reflect the true incidence of this lesion and avoid several diagnostic pitfalls.

References

1.	Thomson JF, Tanner FJ. Tumoral calcinosis. J Bone Joint Surg Am 1949;31:132-40.
2.	Veress B, Malik MO, Hassan AM. Tumoral lipocalcinosis: A clinicopathological study of 20 cases. J Pathol 1976;119:113-7. [PUBMED]
3.	Inclan A. Tumoral calcinosis. JAMA 1943;121:490-5.
4.	Shivkumar VB, Gangane N, Kishore S, Sharma S. Cytological features of idiopathic scrotal calcinosis. Acta Cytol 2003;47:110-1. [PUBMED]
5.	Pinto RG, Baretto G, Rodrigues J. FNAC of calcinosis cutis. J Cytol 2005;22:1997.