Chemical Diagnosis of Calcium Pyrophosphate Deposition Disease of the Temporomandibular Joint: A Case Report.

Masahiko Terauchi,Tohru Ikeda,Rina Tajima,Yuki Fukawa,Hiroyuki Yoshitake,Motohiro Uo,Tetsuya Yoda

doi:10.3390/diagnostics12030651

Abstract

Calcium pyrophosphate dihydrate (CPPD) deposition disease is a benign disorder characterized by acute gouty arthritis-like attacks and first reported by McCarty. CPPD deposition disease rarely occurs in the temporomandibular joint (TMJ), and although confirmation of positive birefringence by polarized light microscopy is important for diagnosis, it is not reliable because other crystals also show birefringence. We reported a case of CPPD deposition disease of the TMJ that was diagnosed by chemical analysis. A 47-year-old man with a chief complaint of persistent pain in the right TMJ and trismus was referred to our department in 2020. Radiographic examination revealed destruction of the head of the mandibular condyle and cranial base with a neoplastic lesion involving calcification tissue. We suspected CPPD deposition disease and performed enucleation of the white, chalky masses. Histopathologically, we confirmed crystal deposition with weak birefringence. SEM/EDS revealed that the light emitting parts of Ca and P corresponded with the bright part of the SEM image. Through X-ray diffraction, almost all peaks were confirmed to be CPPD-derived. Inductively coupled plasma atomic emission spectroscopy revealed a Ca/P ratio of nearly 1. These chemical analyses further support the histological diagnosis of CPPD deposition disease.

Highlights

McCarty was the first to report a case of calcium pyrophosphate dihydrate (CPPD)crystal deposition disease, a rare benign crystalline arthropathy known as pseudogout [1,2]
We describe a case of CPPD deposition disease of the temporomandibular joint (TMJ) diagnosed using chemical analyses, scanning electronic microscopy (SEM)/energy-dispersive X-ray spectroscopy (EDS), XRD, and inductively coupled plasma atomic emission spectroscopy (ICP-AES)
The masses consisted of chondroid tissue with island-like or nodular deposition of basophilic crystals (Figure 6A)

Summary

Introduction

Crystal deposition disease, a rare benign crystalline arthropathy known as pseudogout [1,2]. This disease is characterized by the accumulation of CPPD crystals in various intra-articular and periarticular tissues [3]. Almost all previously reported cases of CPPD deposition disease of the TMJ were diagnosed using a polarized microscope to find positive birefringence. We consider this modality insufficient for diagnosis because, in addition to those in CPPD and gout, many birefringent crystals such as those of calcium oxalate, synthetic steroids, and ethylenediaminetetraacetic acid are present in the joint fluid, joint tissue, and bone [11]. We describe a case of CPPD deposition disease of the TMJ diagnosed using chemical analyses, scanning electronic microscopy (SEM)/energy-dispersive X-ray spectroscopy (EDS), XRD, and inductively coupled plasma atomic emission spectroscopy (ICP-AES)

Results

Discussion

Conclusion