Calcified Mass Research Articles

Leave No Stone Unturned: A Case of an Actinomyces Rhinolith Presenting With Chronic Cough and Throat Pain.

Actinomycosis infection in the nasal cavity, especially an actinomyces rhinolith, is extremely rare. It should be considered in cases where a heterogenous calcified mass is found within the nasal cavity on endoscopy and radiographically. Treatment includes surgical debridement and a prolonged course of antibiotics, unique from the more typically encountered fungus ball. This case highlights the broad differential for chronic cough and throat pain and the importance of considering sinonasal contributions to throat symptoms.

Yellow Ligament Calcification Complicated by Cervical Myelopathy: A Case Report and Review of the Literature

Calcification of the yellow ligament (CLJ) of the cervical spine is a rare condition, described mainly in Japanese. We report a new case of CLJ of the cervical spine causing cervical myelopathy in a 62-year-old Moroccan patient. The myelopathy was revealed by spastic tetraparesis and posterior cord syndrome. The diagnosis of spinal cord compression was made by magnetic resonance imaging (MRI). The CT scan showed massive calcification of the yellow ligament at C4-C5 compressing the right posterolateral aspect of the spinal cord. Treatment consisted of laminectomy of C4-C5 with resection of the calcified yellow ligament. The evolution was rapidly favorable, with complete regression of the symptomatology. CLJ is an extremely rare disease. Its diagnosis is generally easy, its treatment is always surgical, but its pathogenesis remains hypothetical. A review of the literature concerning this pathology is presented.

Prevalence of pulp stones in a selected population in South-east Iran

Background: Pulp stones are calcified masses with unknown etiology in the dental pulp complicating access to the pulp and root canals during root canal therapy. Aim of this study is to determine the prevalence of pulp stones in patients referring to Kerman University School of Dentistry. Methods: This cross-sectional study was undertaken on 4413 teeth in 852 patients and 1052 bitewing and periapical radiographs. The patients were 3–60 years old and had been referred to the Kerman School of Dentistry for various reasons. Data were collected by radiographic evaluations and the use of a checklist and were then analyzed using SPSS version 19 and the chi-square test with the significance level set at 0.05. Results: The prevalence of pulp stones was estimated at 13.4% in the patients, significantly increasing with age (P=0.001). Most pulp stones were 12.2% in the maxilla and 10.4% in the mandible, indicating a significant difference between the two jaws (P=0.001). The highest prevalence of pulp stones was related to the permanent first molars. Most pulp stones were significantly higher in female subjects than in males (P=0.004), with no major difference between the left and right sides (P=0.07). No significant relationship was found between the prevalence of pulp stones with tooth restoration and dental caries (P=0.130). Conclusion: The prevalence of pulp stones increased significantly with age. In this study, the youngest participant was a 4-year-old male, and the oldest was a 60-year-old female.

Gallstone Ileus: A Case Report in a 74-Year-Old Male.

Gallstone ileus is a rare complication of complicated gallbladder disease. Typically the result of a cholecystocholeduodenal fistula, a gallstone enters the small bowel and impacts in the ileum causing an obstruction. In this case study, a 74-year-old male presented to the emergency department with nausea, vomiting, and constipation for 2 weeks. CT revealed pneumobilia and a 3.1 cm calcified mass in the terminal ileum. The patient was successfully treated with a robotic-assisted enterotomy alone without complications.

Different outcomes following parathyroidectomy in patients with uremic tumoral calcinosis: two case reports

BackgroundUremic tumoral calcinosis (UTC) is a rare complication in hemodialysis patients, whose mechanism remains incompletely understood. We report two cases with UTC who experienced completely different patterns of regression following parathyroidectomy, although there were no significant differences in serum calcium levels, parathyroid hormone, or phosphorus production between the two patients.Case presentationCase 1 had a substantial improvement in soft tissue calcification. However, in Case 2, one calcified mass was partially absorbed, while the others were aggravated with severe microvascular calcification and subcutaneous extravascular calcification. Whole-exome sequencing data revealed five mutation sites associated with atherosclerosis.ConclusionThe different outcomes in UTC patients after PTX are rare. Further studies are required to elucidate the mechanism of paradoxical changes occurring in patients with UTC after parathyroidectomy.

Irritation of Dental Sensory Nerves Promotes the Occurrence of Pulp Calcification

IntroductionPulp calcification (PC) often appears in strong association with nerve fiber bundles, which indicates the important role of dental nerves in the formation of PC. Additionally, given that sensory nerves and calcitonin gene-related peptide (CGRP) secreted from sensory nerve fibers are involved in physiological and pathological bone formation, we aimed to determine whether chronic irritation of sensory nerves can promote the occurrence of PC. MethodsA sensory nerve irritation rat model was established via ligation of the inferior alveolar nerve (IAN), and face grooming behavior was analyzed as a measure of pain sensation. Two months post-surgery, PC was determined by imaging and histologic analyses. ResultsRats in the IAN-chronic constriction injury (IAN-CCI) group showed spontaneous pain-associated behavior after the operations and pain tolerance on the 60th postoperative day. The imaging and histological analysis showed more calcified particles in the IAN-innervated first and second molars after day 60 of the dental sensory nerve irritation. These calcified masses had a dentin-like structure that contained sparse, irregularly oriented tubules. Compared to the control and sham groups, the odontoblasts located in the periphery of radicular pulp aligned along a thicker layer of predentin; which expressed more nestin with longer and stouter processes in the IAN-CCI group. Additionally, more CGRP-positive nerves were observed in the IAN-CCI group. ConclusionsIrritation of sensory nerves promotes PC formation, and the increased density of CGRP-immunolabeled fibers probably contributes to this process. This highlights the significance of dental sensory nerves in the formation of PC.

Dystrophic Calcified Mass Found in the Semimembranosus Muscle in a Cadaver: A Case Report

Most of the soft tissue calcified mass formations are sporadic incidences that occur in an idiopathic form. Ectopic calcification changes were seen in various soft tissues beyond the skeleton. They are often asymptomatic masses located in the superficial or deeper aspect of the body, but may not be related to the bone directly. Increased levels of serum calcium, phosphate, or Vitamin D hypervitaminosis may be associated with the calcification process, causing mass accretion in the tissues like bones of limbs, and cranium, or showing some dental abnormalities. During the routine dissection of the hamstring compartment of the left lower limb in a male cadaver aged around 70 years in the Department of Anatomy, we noticed nodular fragments and lengthy slender pieces, which were hard in consistency and bony in its appearance found within the semimembranosus muscle. The histopathology of these masses was revealed as “Dystrophic Calcified Masses”. A holistic description of calcification changes in the soft tissues will be considered in the article. Keywords: calcification, dystrophy, hypervitaminosis

Clinical Images: Massive soft-tissue calcification in primary Sjogren syndrome.

Clinical Images: Massive soft-tissue calcification in primary Sjogren syndrome.

Medial Collateral Ligament Calcification, Presenting as Knee Pain. An unusual Case Report

Background: The tibial collateral ligament, also known as the medial collateral ligament (MCL), is a ligament extending from the medial epicondyle of the femur to the posteromedial crest of the tibia. The ligament is a broad and strong band that mainly functions to stabilize the knee joint in the coronal plane on the medial side Since MCL calcification is not a frequent knee pain manifestation, exclusion of other confusing clinical mimicries is of paramount importance. Here, in this report, we describe a well-circumscribed calcific deposit in the left femoral condylar attachment of MCL reported very rarely in the medical literature. 
 Case Report: A 37-year-old laborer presented to the Outpatient department with pain and flexion deformity of the Right knee for 6 months. He walked on a flexed knee with a limping gait. A plain radiograph of the right was taken in AP and Lateral view which showed a massive well-defined calcification at the medial side of the knee joint. Considering the large size of the lesion, surgical treatment was chosen. Intra-operatively, as the MCL was involved a reconstruction was done using the semitendinosus tendon.
 Conclusion: Chronic pain located at the medial side of the knee is not always osteoarthritic pain. Thorough clinical and radiological investigation with plain radiographs and MRI in some cases is mandatory. Calcification or ossification of the medial collateral ligament of the knee responds well to conservative treatment. Surgical resection is needed in some cases with larger lesions.

Pulp stones and its relation with co-morbid diseases

Pulp stones are nodular, calcified masses that can develop in the pulp of healthy, damaged or even developing teeth. In addition to a number of other factors and idiopathic factors, a number of theories have been put forward about the etiological factors behind the occurrence of pulp stones. These include age, genetic susceptibility, pulp degeneration, pulp circulatory disturbances, inductive interactions between pulp tissue and epithelium, and orthodontic tooth movements. Recently, pulp stones development has been linked to a number of systemic disorders, including diabetes, renal diseases, autoimmune diseases, and coronary artery disease. Osteopontin appears to contribute to plaque calcification and is a component of atheromatous plaques. Calcifications have also been noted in renal and carotid arteries with osteopontin, and numerous studies have shown a relationship between atheromatous plaques in arteries and the development of pulp stones. The development of pulp stones, kidney stones, joint calcification, and atheromatous plaques in arteries are thought to share the same mechanism of apatite formation. It has been hypothesized that the biological apatite that nanobacteria produce on their cell walls, which is comparable to kidney stones and calcified tissue, may be a common cause of both pulp stones and atheromatous plaques seen in coronary artery disease. As per the findings of several studies, pulp stones are more severe in coronary artery disease patients. The purpose of this research is to review the available information about pulp stones and its relation with co-morbid diseases.

Popcorn Appearance of Severely Calcified Uterine Leiomyoma: Image-Pathological Correlation

Calcified subserous leiomyoma is a rare benign tumor commonly seen in the postmenopausal age group. Cases with severely calcified degeneration all over the mass are extremely rare. It causes diagnostic confusion with the solid calcified adnexal mass and the large bladder calculi in the pelvis. We hereby present a case of heavily calcified subserous uterine leiomyoma in a 66-year-old postmenopausal woman. An X-ray of the abdomen and pelvis and CT scan showed a pelvic mass with scattered popcorn appearance in the pelvis, representing severely calcified discrete spots all over the mass. Sonographically, different from typical uterine leiomyomas which exhibit recurrent refractory shadowing patterns, our case showed heavy homogeneous acoustic shadow obscuring all structures beneath the mass surface, resulting in a suboptimal ultrasound examination. Accordingly, CT scans, which are usually not a primary tool for the diagnosis of uterine leiomyomas, are helpful to characterize the mass and identify their organ of origin. The case presented here was treated with a hysterectomy with bilateral oophorectomy and was post-operatively confirmed for severely calcified subserous leiomyomas.

Incidental findings involving the temporomandibular joint on computed tomography and magnetic resonance imaging.

The temporomandibular joint (TMJ) is frequently imaged in head and neck computed tomography (CT) and magnetic resonance imaging (MRI) studies. Depending on the indication for the study, an abnormality of the TMJ may be an incidental finding. These findings encompass both intra- and extra-articular disorders. They may also be related to local, regional or systemic conditions. Familiarity with these findings along with pertinent clinical information helps narrow the list of differential diagnoses. While definitive diagnosis may not be immediately apparent, a systematic approach contributes to improved discussions between clinicians and radiologists and better patient management.

Fulminant myocarditis with massive myocardial calcification in an infant.

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Pictorial review of computed tomography and magnetic resonance imaging findings of cardiovascular manifestations of IgG4-related disease.

This study includes a series of 5 cases demonstrating cardiovascular manifestations of findings of IgG4-related disease. Two cases demonstrate peri-aortic soft tissue thickening in the infrarenal abdominal aorta and bilateral ostio--proximal common iliac artery. In 2 cases there were circumferential soft tissue lesions around the arch of the aorta. One of the cases showed coexistent, biopsy-proven Riedel's thyroiditis and infiltrative soft tissue along the right atrial wall and interatrial septum. In one case there was a partly calcified mass in the left hemi-thorax consistent with a diagnosis of IgG4-related fibrosing mediastinitis.

Detection of pulpal calcifications on bite-wing radiographs using deep learning.

Pulpal calcifications are discrete hard calcified masses of varying sizes in the dental pulp cavity. This study is aimed at measuring the performance of the YOLOv4 deep learning algorithm to automatically determine whether there is calcification in the pulp chambers in bite-wing radiographs. In this study, 2000 bite-wing radiographs were collected from the faculty database. The oral radiologists labeled the pulp chambers on the radiographs as "Present" and "Absent" according to whether there was calcification. The data were randomly divided into 80% training, 10% validation, and 10% testing. The weight file for pulpal calcification was obtained by training the YOLOv4 algorithm with the transfer learning method. Using the weights obtained, pulp chambers and calcifications were automatically detected on the test radiographs that the algorithm had never seen. Two oral radiologists evaluated the test results, and performance criteria were calculated. The results obtained on the test data were evaluated in two stages: detection of pulp chambers and detection of pulpal calcification. The detection performance of pulp chambers was as follows: recall 86.98%, precision 98.94%, F1-score 91.60%, and accuracy 86.18%. Pulpal calcification "Absent" and "Present" detection performance was as follows: recall 86.39%, precision 85.23%, specificity 97.94%, F1-score 85.49%, and accuracy 96.54%. The YOLOv4 algorithm trained with bite-wing radiographs detected pulp chambers and calcification with high success rates. Automatic detection of pulpal calcifications with deep learning will be used in clinical practice as a decision support system with high accuracy rates in diagnosing dentists.

Huge Aortic Aneurysm? Massive Fistula!

A 73 year old man presented to the emergency room with lumbar pain, dyspnoea, and oliguria. An abdominal tender pulsatile mass with a thrill and bilateral lower limb oedema were noted. Abdominal X ray revealed a giant calcified spherical mass (A; arrows). Computed tomography angiography showed a 14 cm infrarenal abdominal aortic aneurysm associated with inferior vena cava contrast filling during the arterial phase (B; arrow). Blood work revealed a serum creatinine of 5.2 mg/dL (basal 0.6 mg/dL) and N terminal pro B type natriuretic peptide of 25 000 pg/dL.

Myositis ossificans circumscripta after surgery and radiotherapy and during sunitinib treatment: a case report

BackgroundMyositis ossificans circumscripta is a self-limiting, benign, ossifying lesion that can affect any type of soft tissue. It is most commonly found in muscles as a solitary lesion. A history of recent trauma has been reported in approximately 50% of cases. Clinically, MOC presents as a painful swelling, which rapidly increases in size. The pain and inflammatory symptoms spontaneously disappear after approximately 2–6 weeks, and the mass stabilizes or decreases. Radiologically, myositis ossificans circumscripta can be divided into two phases. The first is the acute phase, which is followed by the mature phase 2–6 weeks later. During the acute phase, the radiological aspect does not show any specific abnormality. In the mature phase, plain radiographs and computed tomography show blurred calcifications around a hypodense center. We describe here the first case of myositis ossificans circumscripta, with appropriate follow-up, occurring during sunitinib exposure.Case presentationWe report a case of myositis ossificans circumscripta in a 34-year-old man (ethnicity unknown) receiving sunitinib for metastatic alveolar soft part sarcoma of the left thigh after surgery and radiotherapy. Four months after the first dose of sunitinib, the patient experienced painful swelling in the surgical scar area. Magnetic resonance imaging showed diffuse and marked edema of the anterior compartment of the thigh, without nodular lesions circumscribing a central core, and without bone signal abnormality. The increased visibility of the intermuscular fascia and convergence of normal muscle fibers (black hole effect), without the displacement seen in tumors, were suggestive of myositis. Therefore, antiangiogenic treatment was discontinued, and the symptoms rapidly resolved within a few days. Three weeks after the discontinuation of sunitinib, the inflammatory findings completely disappeared. Two months after the diagnosis of myositis ossificans circumscripta, plain radiographs and computed tomography showed an extensive calcified mass measuring > 12 cm. The continuation of favorable clinical outcomes was confirmed.ConclusionsTo the best of our knowledge, this is the first case of myositis ossificans circumscripta with appropriate follow-up occurring during sunitinib exposure. Owing to multimodal treatment of sarcoma, we cannot rule out the radiotherapy and surgery causality.

An Unusual Presentation of “Two-Thirds Tumor” in the Mandible – A Diagnostic Quandary with a Review of the Literature

An adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of the oral cavity commonly found in the maxillary anterior region and is associated with impacted canines in young females. It rarely occurs in the mandibular region with no impacted or missing teeth. A 21-year-old female reported to the clinic with swelling on the right side of the face for the past six months with no history of pain. Radiographic features such as unilocular radiolucency with thinning of the cortical borders and considerable buccal cortical expansion, as well as some evidence of radiopaque specks were noted. Histopathological examination revealed cells with hyperchromatic nuclei, rosette-like structures with focal areas of calcified mass, and concentric rings resembling Liesegang rings, suggestive of AOT. The tumor was treated surgically by enucleation and cauterization. Although follicular type is a common variant, the tumor presented in this case was of extrafollicular type noted in the mandibular canine and premolar regions of a young female patient with no related impacted tooth.

Analysis of the relationship between placental histopathological aspects of preterm and term birth.

This study aims to establish a correlation between placental histopathological and immunohistochemical (IHC) changes and preterm birth with fetal growth restriction (FGR, formerly called intrauterine growth restriction - IUGR). This prospective study was performed on a group of 30 parturients, with singleton gestation, of which 15 patients gave birth at term, and the other 15 patients gave birth prematurely. After the statistical correlation of the clinical and demographic data with premature birth (PB) and term birth (TB), we performed histological and IHC research on the respective placentae. To observe normal and pathological microscopic placental structures, we used the Hematoxylin-Eosin (HE) and Periodic Acid Schiff-Hematoxylin (PAS-H) classical stainings, but also special immunostaining with anti-cluster of differentiation 34 (CD34) and anti-vascular endothelial growth factor (VEGF) antibodies. We found a statistically significant difference between the TB∕PB categories and the age of the patients, their antepartum weight, the weight of the newborns, and the placenta according to the sex of the newborn. Histological analysis revealed in the case of TB, small areas of perivillous amyloid deposition, with the significant extension of these areas both intravillous and perivillous in the case of PB. Massive intravillous calcifications, syncytial knots, and intravillous vascular thrombosis were also frequently present in PB. With PAS-H staining were highlighted the intra∕extravillous vascular basement membranes, but especially the massive fibrin deposits rich in glycosaminoglycans. By the IHC technique with the anti-CD34 antibody, we noticed the numerical vascular density, higher in the case of TB, but in the case of PB, there were large areas of placental infarction, with a lack of immunostaining in these areas. Through the anti-VEGF antibody, we observed the presence of signal proteins that determined and stimulated the formation of neoformation vessels in the areas affected by the lack of post-infarction placental vascularization. We observed a highly significant difference between placental vascular density between TB∕PB and newborn weight, sex, or placental weight. Any direct proportional link between the clinical maternal-fetal and histological elements yet studied must be considered. Thus, establishing an antepartum risk group can prevent a poor pregnancy outcome.

Review of Sclerosing stromal tumor: A relatively rare ovarian neoplasm

Abstract Introduction/Objective Sclerosing stromal tumor (SST) is sex cord stromal tumor which is rare primary ovarian neoplasm. Because its clinical presentation and imaging findings accurate preoperative clinical diagnosis can be difficult. We report three cases of a sclerosing stromal tumor of ovary and histopathological presentation. Methods/Case Report Our patients had an age ranged from 27-40 years with primary ovarian neoplasm and as incidental in 64-year-old patient. Radiologically lobulated and heterogeneously enhancing, partially calcified masses with nodular rind of avid enhancement about the periphery of the lesion with high risk malignancy were seen. Grossly the masses had firm tan-white, solid, lobulated cut surfaces with patchy calcifications Results (if a Case Study enter NA) Microscopically all the three tumors showed a hyalinized, well-circumscribed nodule with few scattered trabeculae of spindled to plump cells with pale grey cytoplasm within a sclerotic stroma with few staghorn- like blood vessels around the periphery. Scattered calcifications were identified. No mitoses are identified. The reticulin stain showed pericellular focal nested staining pattern. There was no necrosis, pleomorphism, or features of malignancy were identified. Findings were consistent with a sclerosing stromal tumor. Conclusion Ovarian sex cord-stromal tumors are relatively infrequent neoplasms of all primary ovarian tumors. Clinical and sonographic findings alone do not predict the presence of this tumor. SSTs should be considered in differentials in young females with unilateral masses with cystic and solid masses. These tumors carry a good prognosis. Histopathological features along with immunohistochemsitry establish the diagnosis.