Tumoral calcinosis involving the cervical spine.

Osamu Sasaki,Kimihiko Nakamura,Takeo Nashimoto,Hiroyuki Shibuya

doi:10.4103/2152-7806.159074

Osamu Sasaki, Kimihiko Nakamura + Show 2 more

Open Access

https://doi.org/10.4103/2152-7806.159074

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Abstract

Background:Tumoral calcinosis (TC) is a disease of unknown etiology characterized by the presence of calcified masses in the juxta-articular regions of the extremities. Involvement of the cervical spine is very rare. In this report, the characteristics of TC of the cervical spine, including the clinical presentation, radiographic features, and surgical management are discussed.Case Description:A 90-year-old healthy female suffering from numbness of the upper extremities for 3 months presented with a 2-week history of progressive weakness of the lower extremities. A neurological examination revealed mild weakness and sensory impairment of the bilateral upper and lower extremities. Computed tomography (CT) scans demonstrated amorphous calcified masses posterior to the spinous process that extended into the interlaminar spaces of C3/4 and C4/5. The masses involved the posterior elements of C3-C4. Interestingly, CT scans performed 4 years earlier showed subtle calcification of a yellow ligament at C3/4 and C4/5. However, neither calcified masses nor bone erosion were observed. On magnetic resonance (MR) imaging, the mass showed hypointensity on T1- and T2-weighted images. The lesion was compressing the spinal cord and was resected surgically. The pathological findings were consistent with those of TC. The natural history of TC is not understood. However, this case suggests that calcified masses may progress within several years and that the bone around the mass may be involved. Postoperatively, residual masses may disappear spontaneously, while new bone is formed in the erosive lamina and facet.Conclusion:The treatment of choice for TC, if the lesion causes progressive symptoms, is surgical resection.

Highlights

Tumoral calcinosis (TC) is a disease of unknown etiology characterized by the presence of calcified masses in the juxta‐articular regions of the extremities
Tumoral calcinosis (TC) is a pathological entity with an unknown cause characterized by the formation of calcified masses in the periarticular soft tissue.[1,2,5,6]
This disorder is categorized into three different clinical classifications: (i) Lesions developing as a complication of renal dialysis, (ii) lesions with a genetic association, and (iii) lesions occurring sporadically in patients with degenerative or inflamed tissue.[1]

Summary

Conclusion

The treatment of choice for TC, if the lesion causes progressive symptoms, is surgical resection. A computed tomography (CT) scan of the cervical spine [Figure 1] demonstrated an amorphous calcified mass posterior to the spinous process that extended into the interlaminar spaces of C3/4 and C4/5 with encroachment into the spinal canal. Pathological examinations [Figure 4] showed amorphous calcified deposits (A: Hematoxylin and eosin stain, and B: Von Kossa stain) with CD68‐positive macrophages (C: Immunohistochemical staining), suggesting a foreign body reaction. These finding were consistent with a diagnosis of TC. CT performed 7 months after the surgery demonstrated the disappearance of the residual small calcified masses with new bone formation in the involved lamina or facet of C4 [Figure 5b]

DISCUSSION

Methods of treatment