Tumoral calcinosis presenting as a deformity of the thoracic spine

Abstract

<jats:p>The authors describe a rare case of tumoral calcinosis (TC) of the thoracic spine in a 13-year-old boy with thoracic scoliosis. The patient presented with a 2-year history of back pain. He had no personal or family history of bone disease, deformity, or malignancy. Magnetic resonance imaging revealed a heterogeneously enhancing mass involving the T-7 vertebral body and the left pedicle. Computed tomography findings suggested that the mass was calcified and that this had resulted in scalloping of the vertebral body. The lesion was resected completely by using a left T-7 costotransversectomy and corpectomy. The deformity was corrected with placement of a vertebral body cage and pedicle screw fixation from T-5 to T-9. Pathological analysis of the mass demonstrated dystrophic calcification with marked hypercellularity and immunostaining consistent with TC. This represents the third reported case of vertebral TC in the pediatric population. Pediatric neurosurgeons should be familiar with lesions such as TC, which may be encountered in the elderly and in hemodialysis-dependent populations, and may not always require aggressive resection.</jats:p>

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

“…Regarding the spinal TC, the causative role of facet joint degeneration, hypermobility and local inflammation was suggested [3,17,30]. In the majority of cases the calcified masses were observed around posterior vertebral elements [11][12][13][14]18,21,22,24,25,27,30,31,33] and in the spinal canal [2,11,14,15,17,19,21,22,24,25,27,28,36]. Rarely found inside the dura mater of the spine [5,23,29,32].…”

“…Clinical manifestation of spinal TC entailed: palpable tender paraspinal mass [18,20,26,31], axial pain in affected spinal segment [2,3,11,13,15,18-23, 27,30], limited cervical or lumbar range of motion [9,11,13,15,20], tetraparesis [14,22,28,33], paraparesis [2,3,17,30,32,36], lower extremity spasticity [5] and radiculopathy in the distribution of the compressed nerve roots [3,9,13,16,18,29,30,36]. Spinal deformity, such as torticollis or rapidly progressing scoliosis, was the main symptom in case of children [19,24,25].…”

“…Some lobules demonstrated fluid-fluid levels [21,25,26]. The masses most frequently presented low signal intensity on both T1 and T2-weighted MR images [2,3,11,15,16,[18][19][20][21]23,25,27,29,30]. Mixed signal intensity was also observed [3,5,13,17,22,28,32,36].…”

“…Spinal location, which was first recognized by Riemenschneider and Ecker in 1952 [9] is considered to be very rare [3,5,. In 2011, Kalani reported by that time [19]. Additionally, six cases were reported between 2011 and 2015 [2,15,16,19,21,33] and prior Pakasa and Kalengayi (1997) mentioned four cases diagnosed by means of biopsies of lumbar spine [7].…”

“…In 2011, Kalani reported by that time [19]. Additionally, six cases were reported between 2011 and 2015 [2,15,16,19,21,33] and prior Pakasa and Kalengayi (1997) mentioned four cases diagnosed by means of biopsies of lumbar spine [7]. The largest clinical series of 21 patients with spinal TC was published in 2001 by Durant et al, who concluded that histology of paraspinal lesions was identical to that of TC seen elsewhere in the body [3].…”