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Presented by Edward McCarthy, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 5: A 30-year-old patient on renal dialysis developed a swelling in the shoulder area.
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1. Question
Week 257: Case 5
A 30-year-old patient on renal dialysis developed a swelling in the shoulder area. A radiograph demonstrated soft tissue radiodensities around the shoulder joint./images/feb 2006 case 5 1.jpg
/images/feb 2006 case 5 2.jpg
/images/feb 2006 case 5 3.jpgCorrect
Answer: Tumoral calcinosis
Histology: none provided
Discussion: Tumoral calcinosis is a disorder where calcium hydroxyapatite, calcium sulphate, and calcium phosphate crystals are deposited as dystrophic calcification directly in soft tissues. This disorder most frequently occurs in patients on renal dialysis whose calcium balance is disturbed. The dystrophic calcification incites a very prominent histiocytic and foreign body giant cell reaction.
The lesion is not an osteosarcoma. Although the radiodensity on the radiograph raises the suspicion of a bone-forming lesion, there is no bone formation in the histologic sample.
The lesion is not a chondrosarcoma because there is no cartilage in this lesion. The radiograph may raise the possibility that this is a cartilage tumor. However, a histologic examination contradicts this idea.
Incorrect
Answer: Tumoral calcinosis
Histology: none provided
Discussion: Tumoral calcinosis is a disorder where calcium hydroxyapatite, calcium sulphate, and calcium phosphate crystals are deposited as dystrophic calcification directly in soft tissues. This disorder most frequently occurs in patients on renal dialysis whose calcium balance is disturbed. The dystrophic calcification incites a very prominent histiocytic and foreign body giant cell reaction.
The lesion is not an osteosarcoma. Although the radiodensity on the radiograph raises the suspicion of a bone-forming lesion, there is no bone formation in the histologic sample.
The lesion is not a chondrosarcoma because there is no cartilage in this lesion. The radiograph may raise the possibility that this is a cartilage tumor. However, a histologic examination contradicts this idea.
