Idiopathic scrotal calcinosis

Abstract

Idiopathic scrotal calcinosis (ISC) is a rare and benign disorder first described by Lewinski in 1883. It is characterized by the presence of multiple yellowish-white calcified asymptomatic nodules gradually increasing in size, appearing in the scrotal skin. It appears mainly in men aged 20–40 years. Histopathology ISC reveals calcium deposits within the dermis that may be associated with giant cell reaction. The calcified intradermal nodules that are seen in this condition occur in the presence of normal calcium and phosphate metabolism. Many studies done on this entity spanning over the past years have failed to demonstrate its origin. Though few studies suggest this entity to be a result of dystrophic calcification in a preexisting cyst, many other studies failed to demonstrate histological evidence to the same. Hence, whether this condition is idiopathic or as a result of dystrophic calcification of preexisting cysts including epidermal, eccrine epithelial cyst, or degenerated dartos muscle remains a controversial issue. Associations with connective tissue diseases such as scleroderma, dermatomyositis, and systemic lupus erythematosus have also been known. Surgical excision is the gold standard treatment for this disease. We report two cases, one in a 59-year-old and other in a 47-year-old male, with no known comorbidities, both presenting with asymptomatic multiple hard scrotal nodules. Both the cases revealed dermal deposits of calcium with normal serum calcium and phosphate levels. There was no evidence of keratinous material, epithelial-lined cystic spaces, or preexisting duct-like structures within or around the foci of calcification, suggesting this entity to be distinct from dystrophic calcification in a preexisting cyst. Surgical excision was done with no evidence of recurrence.