Tumoral calcinosis of the cervical spine in a dialysis patient. Case report and review of the literature

Abstract

The authors present a case of tumoral calcinosis (TC) in a patient with chronic renal insufficiency. The clinical course, imaging features and microscopic findings are detailed. A 60-year-old woman with a 4-year history of hemodialysis presented with a painful mass in the right posterior cervical triangle. The neuroimaging revealed polycystic mass bulging from the C3-C5 facet joints and lamina on the right. The majority of cystic mass was excised and microscopic features of the specimen were consistent with TC. Tumoral calcinosis is a rare disease characterized by calcium salt deposits in periarticular soft tissue, which enlarge to form tumor-like cystic masses containing chalky calcareous material. TC is typically seen around large joints but rarely in the spine. Review of past publications provided six cases of TC involving the spine in dialyzed patients.

Tumoral Calcinosis of Thoracic Spine Associated with Vertebral Fracture and Inflammatory Reactions

“…After rehabilitation, she was able to stand and use a wheelchair with the help of an assistant. 3 Case Reports in Orthopedics calcification as chronic renal failure, hyperparathyroidism, hypervitaminosis D, scleroderma, pseudoxanthoma elasticum, malignancy, and milk-alkali syndrome [5]. Our patient had no familial history.…”

“…Most instances of tumoral calcinosis are found to occur in the shoulder, hip, and metatarsophalangeal joint. In a review by Smack et al, tumoral calcinosis was classified into the following three subtypes based on the pathogenesis [ 2 , 3 ]:(1) primary normophosphatemic tumoral calcinosis without metabolic abnormalities, with no evidence of familial patterns [ 4 ], (2) primary hyperphosphatemic tumoral calcinosis with strong familial patterns, and (3) secondary tumoral calcinosis with concurrent disease capable of causing soft tissue calcification as chronic renal failure, hyperparathyroidism, hypervitaminosis D, scleroderma, pseudoxanthoma elasticum, malignancy, and milk–alkali syndrome [ 5 ]. Our patient had no familial history.…”

Multiple uremic tumoral calcinosis in periarticular soft tissues with chronic renal failure: a case report

“…Radiologic methods can reflect histological characteristics in vivo without invasive In particular, axial CT well delineates a calcific mass and cysts, with the appearance of fluid-fluid levels caused by calcium layering, which is commonly termed the sedimentation sign (7). This is probably due to the granulomatous foreign body reaction or hypervascularity of the lesion (8). The lesion may also appear homogeneous, suggesting reduced metabolic activity and a low likelihood of growth (9).…”

Symptomatic Cervical Tumoral Calcinosis due to Cosmetic Body Contouring Mineral Oil Injections

“…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].…”