New method of local adjuvant therapy with bicarbonate Ringer’s solution for tumoral calcinosis: A case report

BACKGROUND Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues,occurring in hemodialysis patients.Calcium phosphate crystals are mainly composed of hydroxyapatite,which is highly infilt-rative to tissues,thus making complete resection difficult.An adjuvant method to remove or resolve the residual crystals during the operation is necessary.CASE SUMMARY A bicarbonate Ringer’s solution with bicarbonate ions(28 mEq/L)was used as the adjuvant.After resecting calcium phosphate deposits of tumoral calcinosis as much as possible,while filling with the solution,residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field.A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders,bilateral hip joints,and the right foot.A shoulder lesion was resected,but the calcification remained and early re-deposition was observed.Considering the difficulty of a complete rection,we devised a bicarbonate dissolution method and excised the foot lesion.After resection of the calcified material,the residual calcified material was washed away with bicarbonate Ringer’s solution.CONCLUSION The bicarbonate dissolution method is a new,simple,and effective treatment for tumoral calcinosis in hemodialysis patients.

Review of tumoral calcinosis: A rare clinico-pathological entity

Tumoral calcinosis(TC) has long been a controversial clinico-pathological entity. Its pathogenesis and genetic background have been gradually unravelled since its first description in 1943. According to the presence or absence of an underlying calcifying disease process, TC has been divided into primary and secondary varieties. Two subtypes of the primary variety exist; a hyperphosphatemic type with familial basis represented by mutations in Gal NAc transferase 3 gene(GALNT3), KLOTHO or Fibroblast growth factor 23(FGF23) genes, and a normo-phosphatemic type with growing evidence of underlying familial base represented by mutation in SAMD9 gene. The secondary variety is mainly associated with chronic renal failure and the resulting secondary or tertiary hyperparathyroidism. Diagnosis of TC relies on typical radiographic features(on plain radiographs and computed tomography) and the biochemical profile. Magnetic resonance imaging can be done in difficult cases, and scintigraphy reflects the disease activity. Treatment is mainly surgical for the primary variety; however, a stage-oriented conservative approach using phosphate binders, phosphate restricted dietsand acetazolamide should be considered before the surgical approach is pursued due to the high rate of recurrences and complications after surgical intervention. Medical treatment is the mainstay for treatment of the secondary variety, with failure warranting subtotal or total parathyroidectomy. Surgical intervention in these patients should be kept as a last resort.

Recuperation of severe tumoral calcinosis in a dialysis patient: A case report

BACKGROUND One of the common late sequela in patients with end-stage renal disease(ESRD)is the calcium phosphate disorder leading to chronic hypercalcemia and hyperphosphatemia causing the precipitation of calcium salt in soft tissues.Tumoral calcinosis is an extremely rare clinical manifestation of cyst-like soft tissue deposits in different periarticular regions in patients with ESRD and is characterized by extensive calcium salt containing space-consuming painful lesions.The treatment of ESRD patients with tumoral calcinosis manifestation involves an increase in or switching of renal replacement therapy regimes and the adjustment of oral medication with the goal of improved hypercalcemia and hyperphosphatemia.CASE SUMMARY We describe a 40-year-old woman with ESRD secondary to IgA-nephritis and severe bilateral manifestation of tumoral calcinosis associated with hypercalcemia,hyperphosphatemia and tertiary hyperparathyroidism.The patient was on continuous ambulatory peritoneal dialysis and treatment with vitamin D analogues.After switching her to a daily hemodialysis schedule and adjusting the medical treatment,the patient experienced a significant dissolution of her soft tissue calcifications within a couple of weeks.Complete remission was achieved 11 mo after the initial diagnosis.CONCLUSION Reduced patient compliance and subsequent insufficiency of dialysis regime quality contribute to the aggravation of calcium phosphate disorder in a patient with ESRD leading to the manifestation of tumoral calcinosis.However,the improvement of the treatment strategy and reinforcement of patient compliance enabled complete remission of this rare disease entity.

Calcinosis circumscripta in a captive African cheetah(Acinonyx jubatus)

This article reports a first case of calcinosis circumscripta in a captive African cheetah(Acinonyx jubatus).Histopathology demonstrated well defined multiple cystic structures containing granular,dark basophilic materials with peripheral granulomatous reaction,characterized by presence of multinucleated giant cells surrounded by a varying amounts of fibrous connective tissues.Special staining with von Kossa revealed black stained deposits confirming the presence of calcium salts.

Effectiveness of Rituximab Therapy on Severe Calcinosis in 4 Children with Juvenile Dermatomyositis

Background: Calcinosis is an important sequela of JDM which may cause significant morbidity and mortality. There is no standard curative treatment for calcinosis but different agents were used with variable efficacy. We report the favorable outcome of rituximab on severe calcinosis in 4 JDM patients and present their clinical data. Patients and Methods: A retrospective chart review of 4 children with JDM and severe calcinosis who received rituximab for relapsing or polycyclic JDM course. Diagnosis and follow up of calcinosis was clinically and by X-ray. Review data included: age of patients at onset of JDM symptoms and diagnosis, clinical and laboratory criteria at diagnosis, disease course and duration of follow up. Data about calcinosis onset, sites, severity and its progression were also included. Further data about rituximab therapy included: dosage, side effects, other treatment used before, during or after this drug and outcome and duration of follow up of calcinosis after therapy. Results: 4 patients (2 male, 2 female), interval between onset of symptoms and diagnosis was 6 - 12 months, course of JDM was polycyclic or relapsing, duration of follow up was 5 - 7 years. Calcinosis was severe causing ulceration, recurrent skin infections and joint limitation. It was not improving despite treatment with different DMARDs and/or bisphosphonates, colchicine and warfarin. Reason to start rituximab was inadequate disease control with conventional DMARDs. All patients received steroids and more than one DMARD before starting rituximab and were continued thereafter, follow up after rituximab was 3 to 5 years. All patients had improvement in disease activity and frequency of admission especially due to complications of calcinosis. One patient had complete clearance of calcinosis for the last 5 years. Others had significant improvement in calcinosis with no new lesions, decreased sites and density and decreased calcinosis related contractures. There were no serious side effects to rituximab. Conclusion: Our study showed the favorable effect of rituximab in treatment of calcinosis in 4 patients with JDM-associated severe calcinosis when it was used with other conventional DMARDs.

Iatrogenic calcinosis cutis in a child affected by Acute Lymphoblastic Leukemia

Iatrogenic calcinosis cutis is a rare disorder that can be due to the intravenous administration of calcium or phosphate-containing infusions such as calcium gluconate or calcium chloride with extravasation. Fortunately, the course of calcinosis cutis is benign in immunocompetent children. The treatment remains supportive therapy. After about 6 months, there is no evidence of tissue calcification. We describe a 4-year-old girl with Acute Lymphoblastic Leukemia (ALL) who developed severe calcinosis cutis in the left humerus after extravasation of calcium gluconate during the treatment for the tumor-lysissyndrome-related hypocalcaemia. Surgical debridement and local wound care were not successful, and so a temporary suspension of chemotherapy was necessary to achieve complete healing of the lesion. Notwithstanding this complication, her ALL is in complete hematological remission after 8 months from the diagnosis. No functional or sensitive impairment due to the cutis has persisted.

Dystrophic Calcinosis in the Hands of a Patient with Rheumatoid Arthritis and Secundary Sjogren’s Syndrome

Salts of calcium phosphate and inorganic phosphate are normally found in serum and extracellular fluids, balancing through poorly understood factors that prevent abnormal tissue deposition of these minerals. However, in those tissues that are injured, especially due to chronic inflammatory processes, a predisposition to the deposition of these minerals is developed, triggering what has been called Dystrophic Calcinosis (DC), common in different Connective Tissue Diseases (CTD), especially dermatomyositis and scleroderma, but there is no a frecuent association with diseases like Rheumatoid Arthritis (RA) and Sj?gren Syndrome (SS). We report a case of a female patient of 63 years old with RA and Secundary SS who presents with DC in the hands and no evidence of other connective tissue.

Fine needle aspiration cytology in tumoral calcinosis cases & review of literature

Objective:To investigate them by the non-invasive technique of fine needle aspiration cytology(FNAC).Methods: In this study cases were described in which FNAC was indicative of tumoral calcinosis.Total numbers of cases studied were 18.Male to female ratio was 1∶8.11 cases(61.11%) were less than 20 years of age.3 cases had history of trauma in the past(16.67%).8 cases had lesions located in the hip region(44.44%).Results:The size of lesion varied from 2.5 to 4 cm.In none of the case diagnosis of tumoral calcinosis was considered clinically.All other investigations were normal and no significant family or medical history was present.Cytology in all cases showed only abundant acellular calcium.The patients on follow up were clinically well with no changes.Conclusion:The cases are interesting,since the cytohistological findings in the aspirate sample are strongly indicative of tumoral calcinosis.

瘤样钙盐沉着症的超声表现

目的探讨瘤样钙盐沉着症的临床及超声表现。资料与方法回顾性分析2016年1月—2022年5月四川省人民医院经手术病理证实的44例瘤样钙盐沉着症患者的临床及超声资料,总结临床表现(年龄、性别、压痛、质地、皮肤改变、血磷、碱性磷酸酶、血钙)及超声表现(病变部位、大小、内部回声、边界、后方声影、与周围结构的关系、血流信号)。结果44例瘤样钙盐沉着症患者共47个病灶,17个病灶位于臀部,9个病灶位于肢体,33个病灶呈无痛性包块。44例患者血钙及碱性磷酸酶均正常,5例血磷升高。瘤样钙盐沉着症主要位于皮肤层、脂肪层或肌层内,不累及骨质。瘤样钙盐沉着症的超声表现分为3型,①结节状钙化灶堆积型:41个(87.23%)病灶表现为沙粒样或颗粒状钙化灶堆积呈结节状,所有结节后方均伴有声影,其中8个病灶边界较清楚,周边可见细窄的低回声带,内未见明显血流信号,10个病灶周边见较宽的低回声带,边界可辨,血流信号较丰富;②囊性团块伴钙化灶沉积型:4个(8.51%)病灶表现为囊性团块,内可见分隔,囊壁及分隔多发细沙样或颗粒样钙化灶沉积伴声影,囊性团块边界不清晰,囊壁可见稀疏血流信号;③孤立粗大钙化灶型:2个(4.26%)病灶表现为孤立粗大钙化灶,后方伴宽大声影,边界较清晰,未见明显血流信号。结论瘤样钙盐沉着症的临床及超声表现具有特征性,多呈无痛性质硬包块,超声表现分为3型,病灶位于软组织内,不累及骨质。

血清长链非编码RNA肌动蛋白纤维相关蛋白1-反义RNA1水平与钙化性主动脉瓣狭窄病人左心室功能的相关性研究

目的 分析血清长链非编码RNA(lncRNA)肌动蛋白纤维相关蛋白1-反义RNA1(AFAP1-AS1)表达水平与钙化性主动脉瓣狭窄(CAS)病人左心室收缩及舒张功能的相关性。方法 于2020年1月至2021年12月,选取中国中医科学院广安门医院就诊的CAS病人129例作为CAS组[左心室射血分数(LVEF)≥50%],同期该院健康志愿者130例作为对照组。收集病人人口学资料、超声及实验室生化指标,检测血清lncRNA AFAP1-AS1表达。受试者操作特征曲线(ROC曲线)分析血清lncRNA AFAP1-AS1诊断CAS效能。结果 对照组血清lncRNA AFAP1-AS1表达水平(1.15±0.18)低于CAS组(1.58±0.30)(P<0.001)。轻度狭窄者血清lncRNA AFAP1-AS1表达水平(1.37±0.26)低于中、重度狭窄者,而中度狭窄者lncRNA AFAP1-AS1表达水平(1.59±0.30)低于重度狭窄者(1.79±0.34)(P<0.001)。ROC结果显示,血清lncRNA AFAP1-AS1诊断CAS、重度狭窄的曲线下面积分别为0.86[95%CI:(0.82,0.91)]、0.88[95%CI:(0.82,0.94)]。CAS组AVA水平低于对照组(P<0.001),左室舒张末期内径(LVEDD)、左室舒张末期容积(LVEDV)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左房前后径(LAD)、主动脉瓣平均压差(PGmean)、主动脉瓣峰值流速(Vmax)水平高于对照组(均P<0.001)。相关性分析显示,血清lncRNA AFAP1-AS1与LVEDD、Vmax、二尖瓣口舒张早期血流速度峰值(E峰)、二尖瓣口舒张晚期血流速度峰值(A峰)、LVEDV、PGmean、LVESD呈正相关(r=0.60、0.66、0.72、0.68、0.56、0.57、0.50,均P<0.001),与LVEF、AVA呈负相关(r=-0.78、-0.62,均P<0.001)。结论 CAS病人血清lncRNA AFAP1-AS1表达水平升高,与CAS病情严重程度以及左心室舒张、收缩功能有关,并可作为无创血清标志物辅助临床诊断CAS。

血管钙化对超声引导下经皮腔内血管成形干预动静脉瘘狭窄后通畅率的影响

目的观察血管钙化对以超声引导下经皮腔内血管成形(UG-PTA)干预动静脉瘘(AVF)狭窄后通畅率的影响。方法回顾性分析48例因自体或人工AVF狭窄而接受UG-PTA的慢性肾脏病维持性血液透析(HD)患者,根据超声所示有无AVF钙化将其分为钙化组(n=21)及非钙化组(n=27);记录UG-PTA技术成功率、临床治疗成功率及UG-PTA相关不良事件。分别于UG-PTA后3、6、9、12、24及36个月以超声评价AVF通畅情况,计算初级及次级通畅率,并以Kaplan-Meier生存曲线进行分析。结果对48例均于UG-PTA后成功实施3次以上有效HD,UG-PTA技术及临床治疗成功率均为100%(48/48);未见严重不良事件。钙化组UG-PTA后3、6、9、12、24及36个月初级通畅率分别为75.89%、37.95%、37.95%、27.10%、14.46%及0,次级通畅率分别为95.24%、95.24%、95.24%、89.95%、83.03%及83.03%;非钙化组初级通畅率分别为92.31%、73.08%、57.69%、53.85%、36.15%及36.15%,次级通畅率分别为100%、100%、100%、100%、95.24%及95.24%;钙化组初级通畅率低于非钙化组(P<0.05),而组间次级通畅率差异无统计学意义(P>0.05)。结论以UG-PTA干预AVF狭窄后,局部血管钙化为其初级通畅率的危险因素,但对次级通畅率无明显影响。

阴囊特发性钙质沉着症1例

患者男,32岁,阴囊多发性黄白色结节8年。皮肤科情况:阴囊表面散在数十个大小不等黄白色结节,最大者直径约为1.3 cm×0.8 cm,部分融合,表面光滑,边界清楚,质韧,与周围组织无黏连。皮损组织病理示:表皮大致正常,真皮中可见大量蓝染均质无定形钙盐沉积,未见囊壁,外周散在多核巨细胞、淋巴细胞浸润。诊断:阴囊特发性钙质沉着症。皮损部分切除,6个月后复发结节。

冠状动脉斑块旋磨术联合血管内碎石术治疗冠状动脉严重钙化3例

冠状动脉钙化(coronary artery calcification,CAC)常见于糖尿病、代谢综合征及慢性肾脏病患者,其进展可反映全身炎症状态,且与经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)支架内血栓形成或再狭窄等不良结局有关。CAC增加PCI难度,通常需修饰钙化灶以保证顺利输送和扩张药物洗脱支架。

肝泡状棘球蚴病CT钙化类型预测其淋巴结转移

目的探讨肝泡状棘球蚴病(HAE)CT钙化类型预测其淋巴结转移的价值0x0E0xFF?厱0x180x0F方法回顾性收集经手术病理确诊的100例HAE患者,以50例存在淋巴结转移者为转移组、50例合并淋巴结反应性增生者为无转移组。对比组间患者一般资料及病灶术前CT表现(包括病灶数目、部位、最大径及钙化类型),对组间差异有统计学意义的临床及CT特征进行多因素logistic回归分析,筛选HAE淋巴结转移的独立预测因素;绘制受试者工作(ROC)曲线,计算曲线下面积(AUC),评价单一钙化类型及其联合其他独立预测因素预测HAE淋巴结转移的效能。结果转移组共62组淋巴结转移,包括39例单组、10例2组及1例3组淋巴结转移。组间肝内病灶部位、最大径及钙化类型差异均有统计学意义(P均<0.05),且均为HAE淋巴结转移的独立预测因素(P均<0.05)。单一CT钙化类型及其联合其他独立预测因素预测HAE淋巴结转移的AUC分别为0.757及0.859,差异有统计学意义(P=0.002)。结论HAE CT钙化类型可有效预测其淋巴结转移;联合病灶部位及最大径可提高预测效能。

八珍汤治疗小腿钙质沉着性慢性溃疡1例报告

给予2022年9月6日株洲市中医伤科医院收治的1例小腿钙质沉着性慢性溃疡患者在敏感抗生素抗感染等对症支持治疗的基础上,局部创面于简单清创切除钙化结节后行碘伏常规换药治疗;治疗7 d后,创面无明显变化,遂予以彻底清创术切除慢性溃疡组织及钙质沉积物,术后行常规碘伏换药治疗,并加服八珍汤。术后12 d,创面完全愈合。

光学相干断层成像指导下冠状动脉旋磨术治疗左前降支严重钙化1例

患者女,71岁,因L4椎体滑脱拟接受手术治疗。入院查体:血压148/66mmHg,腰下部椎体右侧压痛、叩击痛,双下肢活动后疼痛。实验室检查未见明显异常。心脏CT:右冠优势型,左冠状动脉主干(left main coronary artery,LM)狭窄约20%,左前降支(left anterior descending,LAD)近段狭窄70%~80%,左回旋支(left circumflex artery,LCX)近段狭窄约30%,左前降支中段心肌桥(不完全型);右冠状动脉(right coronary artery,RCA)未见明显异常。

肿瘤样钙质沉着症临床特点与疾病风险因素

目的 探讨罕见病肿瘤样钙质沉着症(TC)的临床特点并分析疾病相关风险因素。方法 收集2001年1月~2021年8月就诊于南方医科大学南方医院并经手术病理确诊为TC的患者25例,分析统计临床特点、影像学表现及病理特征。将临床资料齐全的11例住院TC患者与11例年龄、性别匹配的健康对照者进行差异性分析,总结TC患者的生化特征,探讨可能导致该疾病的潜在风险因素。结果 X线多表现为软组织内的高密度钙化影。MRI表现为短T1长T2信号影,肿块内信号不均,边界清晰,局部可与滑膜囊相连。与健康人群相比,TC患者的血尿酸水平升高(P=0.038),血尿酸水平与TC患病率存在正相关关系,高尿酸导致TC的患病风险增加了3倍(RR=3,95%CI:1.041~8.646);高血磷TC患者的血磷和钙磷乘积较健康人群升高(P<0.05),高血磷导致TC的患病风险增加了3.2倍(RR=3.2,95%CI:1.547~6.619)。结论 高血磷和高尿酸增加TC的患病风险,在高尿酸血症和高磷血症患者中需注意鉴别TC,综合临床表现、生化结果、影像学表现、病理诊断使TC得到早期诊治。

尿毒症肿瘤钙化行甲状旁腺切除术后的转归:个案报道

尿毒症患者在软组织内可见多发肿瘤钙化物沉积,伴继发性甲状旁腺功能亢进,其机制尚未明晰,治疗仍具有挑战性。针对其主要的诱发因素,甲状旁腺切除术是关键治疗手段,可以迅速缓解症状。本文报道了1例尿毒症透析患者的肿瘤钙质样转移性钙化在甲状旁腺切除术后出现的不同结果,患者转移性钙化没有明显的吸收,同时出现了严重的微血管钙化和皮下血管外钙化。

Calcinosis cutis in a young man with dermatomyositis

A 25-year-old man with known dermatomyositis was admitted to the University of Leipzig Medical Centre for the first time.The diagnosis was originally made abroad years ago.Current laboratory studies showed elevated C-reactive protein and creatine kinase.Antinuclear antibodies,anti-Mi-2 antibodies,anti-Jo-1 antibodies,and anti-Scl-70 antibodies were negative,and the rheumatoid factor was positive.Nailfold video capillaroscopy(NVC)revealed numerous arborized(or“bushy”)capillaries reflecting dermatomyositis-typical neoangiogenesis.Physical examination showed extensive calcinosis cutis on arms,legs,and trunk.

以四肢多发活动性结节为主要表现的脂肪膜性脂肪坏死合并皮肤钙沉着症一例

59岁女性患者,因反复双小腿红斑、结节伴疼痛1年,加重6个月就诊。皮肤科情况:双小腿散在网状及片状紫红斑、毛细血管扩张及色素沉着,四肢可扪及数个黄豆至蚕豆大小皮下结节,质硬、有压痛,活动度可,表面皮肤正常。结节皮损组织病理示表皮萎缩,真皮水肿,皮下脂肪灶性坏死,脂肪膜呈羽毛状突入脂肪膜微囊,皮下脂肪层可见钙质沉积。诊断:脂肪膜性脂肪坏死合并皮肤钙沉着症。予以沙利度胺50 mg每日3次、白芍总苷胶囊0.6 g每日2次口服等治疗。随访6个月后,部分结节消退,疼痛缓解。