An Unusual Case of Huge Tophaceous Pseudogout Mimicking as a Tumor-Like Lesion around the Ankle Joint: A Case Report and Literature Review

Abstract

Pseudogout or calcium pyrophosphate dihydrate deposition disease (CPPD) primarily affects the joints and the periarticular tissues. Tophaceous or tumoral pseudogout is a rare form of this disease which is seen around the joints of extremities. It can be misdiagnosed as a neoplastic condition because of its clinicoradiological similarities, and thus, a proper histopathological examination is indispensable. We report one such case of extra-articular deposition of the CPPD crystals in a 65-year-old man who presented with an asymptomatic swelling around the left ankle. Radiographs showed a dense homogenous calcification, and FNAC revealed dense calcium deposits with numerous rhomboid-shaped crystals. It was managed by en bloc excision, and postoperative biopsy reports confirmed the diagnosis. Possibility of pseudogout should be kept as a differential diagnosis in patients presenting with calcified soft tissue swellings and should be subjected to a detailed histopathological examination for confirmation.

Pseudotumoral Calcinosis: A Soft Tissue Tumor in a 14-Year-Old Male

“…Whereas magnetic resonance imaging (MRI) is highly efficient, it shows ossification with a low signal intensity on T1 and T2-weighted sequences, otherwise it identifies anatomic extent of the lesion and eliminate any malignity [5,6]. Most often preoperative finding is not always clear essentially if blood tests are normal, until the surgical biopsy and histopathologic analyze that confirm the diagnosis and exclude any malignancy, as calcifications occurs in various tumoral aspects, including benign lesions, such as myositis ossificans, calcinosis in juvenile dermatomyositis, osteolipoma and tophaceous, or malign tumors essentially osteosarcoma, chondrosarcoma or soft tissue sarcomas [7][8][9]. Complete surgical removal of the masses is the treatment of choice; however, other therapeutic option exists, they are common to other calcium deposits diseases involving low-calcium and low-phosphorus diet associated to oral doses of aluminum hydroxide [10].…”

Test yourself: a 49-year-old lady with a history of chronic left hip pain following a fall twenty months earlier

“…Ossifying intra-articular masses represent a variety of pathologies. Synovial chondromatosis, tumoral calcinosis, synovial sarcoma and chondrosarcoma [8] all remain within the differential diagnosis [9]. Since CPPD can mimic soft tissue tumours, it is vital to determine the benign or malignant nature of the lesion in order to avoid inappropriate patient management [10].…”