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Tumoral Calcinosis

Howard T Heller, MD
J Stevan Nagel, MD

May 3, 1996

Presentation

A 59-year-old black woman with a history of diabetes mellitus and chronic renal failure presented with two months of left hip pain.

Imaging Findings

Radiograph of the pelvis, AP view
CT of left thigh
MR of pelvis and thigh
Tc-99m MDP bone scintigraphy of pelvis and thigh

Anteroposterior (AP) pelvic radiograph demonstrates a large soft tissue mass (arrows) with flocculent calcification projecting over the proximal femur. No bony destruction is visible.

Computed tomography (CT) identifies an 11 x 10 x 9 cm lobular calcified mass (arrows) within the musculature of the left lower pelvis and thigh. There is a complete soft tissue plane between the mass and the femur. Edema surrounds the mass.

On magnetic resonance (MR) images, the mass clearly replaces rather than invades the thigh musculature (arrow). The mass is hypointense on all sequences with some high signal areas (arrows), corresponding to edema, on the inversion recovery (STIR) images. Marrow signal in the adjacent femur is normal.

Technetium-99m methylene diphosphonate (Tc-99m MDP) bone scintigraphy indicates dense radiotracer uptake (arrow) over the proximal left thigh.

Differential Diagnosis

Diagnosis

Tumoral calcinosis

Discussion

Tumoral calcinosis is a relatively rare disorder most commonly seen in people of African descent. The etiology is uncertain, but manifestations are often apparent by the second decade of life, affecting the hips most frequently, then buttocks, elbows and smaller joints. The histologic appearance is characterized by densely loculated masses of calcific debris and fluid enclosed by fibrous tissue. Lesions grow quite slowly and rarely cause pain unless there is nerve involvement. Surgical removal is the treatment of choice. Incomplete resection leads to recurrence.

In this case, as in others, the term "tumoral calcinosis" has been used to describe similar lesions seen in conjunction with systemic disorders, such as chronic renal failure and scleroderma.

References

1. Edeiken J, Dalinka M, Karusick D. Edeiken's roentgen diagnosis of diseases of bone. 4th ed. Baltimore: Williams & Wilkins, 1990.

2. Resnik CS. Tumoral calcinosis. Arthritis and Rheumatism 1989 Nov; 32(11):1484-6.

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