Case 34 Answer
History: palpable mass
Answer: Calcinosis of Chronic Renal Failure (ie secondary tumoral calcinosis)
The exact name of this is somewhat confusing. True Tumoral Calcinosis (TC) is generally reserved for the hereditary dysfunction of phosphate regulation which results in large, painless, periarticular calcifications.
So here we have the exact same finding except secondary to chronic renal failure, thus “secondary” or “uremic” tumoral calcinosis. The exact cause is not fully understood by generally believed related to hyperparathyroidism. Interestingly chronic renal failure is actually the most frequent cause of a periarticular calcified mass. And there are no radiographic or histologic differences between the primary or secondary TC.
Findings of TC:
- Amorphous, sometimes cystic, multilobulated calcifications located about a joint.
- Can see layering milk of calcium (sedimentation sign).
- Can be homogeneous (suggesting less metabolic activity and growth)
- Not connected to underlying bone
- No osseous erosion of destruction by the mass
- Typically painless
- Hip > shoulder > elbow > foot > wrist
Treatment: Primarily dialysis and phosphate depletion (diet, phosphate binders)