Tumoral calcinosis: seasonal biochemical studies and chemical studies of eyelid lesion.

Abstract

We recently described (Arch Ophthalmol 1988; 106:725-6) the presence of unique calcific lesions in the eyelids of a young woman with a history of hyperphosphatemic tumoral calcinosis. Here we document that no immediate family members showed similar lesions and that none was hyperphosphatemic. Dental roentgenography revealed characteristic abnormalities in the patient that confirmed the clinical diagnosis of tumoral calcinosis. Seasonal biochemical studies demonstrated persistently increased concentrations of phosphorus and 1,25-dihydroxyvitamin D in her serum. A calcific eyelid excrescence removed from the patient, studied by x-ray diffraction, was found to consist of crystals of hydroxyapatite. Microprobe analysis indicated the major elements in the deposit to be Ca, P, S, and Cl, just as in the periarticular deposits found in tumoral calcinosis. The Ca concentration in the patient's tear fluid, measured by atomic absorption spectrometry, was within the range found in tears of healthy volunteers. Phosphorus was undetectable (less than 30 mumol/L) in tears of the patient and the volunteers. These findings suggest that the eyelid lesions represent a new manifestation of the pathological process that produces the characteristic periarticular calcific masses of tumoral calcinosis.

Tumoral Calcinosis: Report of a Case and Brief Review of the Literature

“…On computed tomography (CT), the appearance of the calcified masses varies from small and solid in some patients to large and cystic in other patients (7); in magnetic resonance imaging (MRI), they display high signal intensity on T2 weighted images (7). Panoramic dental radiograms reveal pathognomonic dental abnormality of short bulbous bulbous roots and partial obliteration of pulp cavities, which strongly support the diagnosis (7,12,20,24,25).…”

“…Laboratory findings, including serum calcium concentration, parathyroid hormone, renal function, and alkaline phosphatase, are normal. Some investigators have reported however an association with variably elevated serum phosphorous levels (1,2,7,(12)(13)(14)(15)(16).…”

“…TC occurs in otherwise healthy individuals (10,28), is more frequent among blacks (3,9,10), and does not affect internal organs (1,14,15,(17)(18)(19). Nevertheless, it has infrequently been found in association with various medical disorders, namely bone and joint changes (8,29,30); systemic amyloidosis (31); arthritis mutilans, Raynaud's phenomenon, lung fibrosis and Sjogren's syndrome (32); carpal tunnel syndrome (33,34); anemia (31); splenomegaly (31); elevated ESR (31), hypergammaglobulinemia (31); calcific lesions in the eyelids; and band keratopathy (12,13).…”

Lacrimal punctal and peripunctal involvement in calcinosis cutis

“…Idiopathic calcinosis cutis includes tumoral calcinosis which predominantly involves the joints and ocular involvement is rare,[ 4 ] and subepidermal calcinosis involves mostly the head and neck region including the ocular adnexa. [ 3 5 ] Serum calcium and phosphorus levels are normal in dystrophic calcinosis and deranged in metastatic variants and calciphylaxis. Idiopathic variants may or may not show such serum abnormalities.…”