Large tumoral calcinosis and pathological femur fracture in a hemodialysis patient with secondary hyperparathyroidism

Abstract

A laboratory evaluation revealed: total alkaline phosphatase 726 U/L (reference range 35-100 U/L), blood urea nitrogen 15.45 mmol/L (reference range 2.95-7.70 mmol/L), creatinine 526 μmol/L (reference range 37-110 μmol/L), calcium 2.42 mmol/L (reference range 2.1-2.7 mmol/L), phosphorus 1.74 mmol/L (reference range 0.81-1.45 mmol/L), and parathyroid hormone (PTH) 169.2 pmol/L (reference range 1.60-6.90 pmol/L). Anteroposterior (AP) radiograph showed a large mass with homogeneous, calcified density around the left proximal femur (Figure 1A). Magnetic Resonance Imaging (MRI) showed the lesion with hypo-intense and ABSTRACT Tumoral Calcinosis (TC) is a rare complication of uremic patients on dialysis. Bone erosion or fracture rarely happens in TC patients. TC is easy to be misdiagnosed as a malignant bone tumor by inexperienced orthopedists. We report the clinical, radiological and magnetic resonance imaging findings in a rare case of large TC which caused femur erosion both and fracture in a 49-year-old woman with uremia and secondary hyperparathyroidism (HPT) on hemodialysis and describe the surgical treatment and pathology results.

Tumoral calcinosis simulating sarcoma

“…Phosphate lowering drugs can help in the complete resolution of small lesions in subtypes 2 and 3. While subtype 1 lesion and large size type 2 and 3 lesions need surgical intervention in the form of excision [9,10,16]. As our patient is categorized as subtype 1, surgical management is done.…”