Presentation
A man, followed for hypertensive heart disease, in chronic end-stage renal failure for 12 years on hemodialysis, consulted for bilateral, painless inguinal swellings, progressively increasing in volume for 1 year. The skin was normal and the rest of the examination was unremarkable in this patient whose general condition was preserved. Biological examinations showed secondary hyperparathyroidism with a PTH of 867 pg/ml (N < 53) and an increase in the phosphocalcic product.
Patient Data
The pelvic radiograph shows a predominantly calcified medial structure projecting onto the pubic symphysis with calcifications of the left thigh and diffuse mediacalcosis
Pelvic CT scan showed a bilateral symmetrical mass, centered on the pubic symphysis, with amorphous, dense cystic and lobulated calcifications, with pubic osteolysis and massive infiltration of the adjacent adductor muscles.
Some of the cystic masses have liquid-liquid levels with calcium sedimentation.
Case Discussion
Tumoral calcinosis is a rare syndrome characterized by lobular, calcified soft tissue masses that occur in periarticular locations, especially: the hip, elbow, shoulder, foot and wrist. The pubic symphysis is a very rare location.
Tumoral calcinosis can be classified as primary (idiopathic or genetic) or secondary. The primary form usually presents with periarticular soft tissue masses in young patients with normal kidney function.
The secondary form is associated mainly with chronic renal failure in hemodialysis patients, and has been attributed to the increase of the phosphocalcic product.
This lesions are characterized by large, amorphous peri-articular calcific densities. In most cases, they demonstrate fluid / calcium levels (calcium/hydroxyapatite crystals in suspension) (Sedimentation sign)
Destruction of the adjacent bone may be the result of erosion due to repeated microtrauma to the bone caused by the large size of the mass and its periarticular location.
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