Metastatic Calcification Research Articles

Calcifications et métabolisme phosphocalcique

Extraosseous calcifications correspond to ubiquitous deposits of intra-tissue calcium salts leading to dysfunction of the affected tissue or organ. There are two types: metastatic calcifications and dystrophic calcifications. Their formation mechanism is by mimicking the physiological mineralization process with an "osteoblast-like" cell. The cause of extra-osseous calcification is variable and depends on risk factors. If the subject is young, you will have to think about a genetic syndrome!

Prevalence and characteristics of patients with incidental cardiac uptake on bone scintigraphy

BackgroundBone scintigraphy is emerging as a confirmatory diagnostic tool for transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to investigate the frequency and clinical characteristics of patients with incidental cardiac uptake and incidental ATTR-CA on bone scintigraphy.MethodsAll bone scintigraphic studies performed at a tertiary teaching hospital between 2011 and 2022 were reviewed retrospectively. Patients who underwent bone scintigraphy to confirm ATTR-CA were excluded. Patients with cardiac uptake of grade 2 or 3 were included and divided into two groups: possible ATTR-CA group and noncardiac amyloidosis (non-CA) group.ResultsOf the 61,432 bone scintigraphic studies performed on 32,245 patients, 23 (0.07%) had grade 2 or 3 cardiac uptake. Nine of 23 patients (39.1%) were assigned to the non-CA group because they showed cardiac uptake from definite other causes or focal uptake that did not match CA. The remaining 14 patients (60.9%) were classified as the possible ATTR-CA group, and five patients were referred to cardiologists and finally diagnosed with ATTR-CA. Two patients were treated with tafamidis. Patients in the ATTR-CA group were significantly older and had a less frequent history of end-stage renal disease than those in the non-CA group. Other characteristics were comparable in both groups.ConclusionsAlthough incidental ATTR-CA in patients undergoing bone scintigraphy for noncardiac reasons is uncommon, if cardiac uptake is observed in elderly patients without metastatic calcification associated with end-stage renal disease, further diagnostic work-up for ATTR-CA as a cause of undiagnosed heart failure should be considered.

Tc-99m-MDP Uptake in Extraosseous Metastases from Ovarian Papillary Serous Adenocarcinoma.

The uptake of Tc-99m-uptake of Tc-99m-methylene diphosphonate (MDP) on bone scintigraphy can be seen at sites other than bone in a varying number of benign and malignant conditions. Extraosseous metastatic calcifications can occur in ovarian papillary serous adenocarcinoma (PSAC). These extraosseous calcifications show Tc-99m-MDP uptake. We report a case of a female in her sixties who had a previous history of PSAC of the ovary. The patient had undergone neoadjuvant chemotherapy (NACT) followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. She also received adjuvant chemotherapy. Tc-99m-MDP bone scan was performed post chemotherapy because the patient complained of lower backache. The scan showed increased uptake in the lower thoracic and lumbar vertebral regions. However, single-photon emission computed tomography/computed tomography (CT) localizes the uptake to metastatic calcified peritoneal deposits. Further 18F-fluorodeoxyglucose positron emission tomography/CT confirmed widespread peritoneal and omental metastatic disease with increased uptake.

Cryptic metastatic calcification after radical nephrectomy in a patient with renal cell carcinoma

Cryptic metastatic calcification after radical nephrectomy in a patient with renal cell carcinoma

Idiopathic Calcinosis Cutis of the left great toe-A case report

Calcinosis cutis, a rare benign disorder, involves systemic calcium deposition in soft tissues, often linked with autoimmune and renal disorders. Pathophysiology varies among its five main types: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis. Dystrophic calcification, the most common type, is associated with normal calcium and phosphorus levels and autoimmune diseases. Metastatic calcification, on the other hand, arises from abnormal serum calcium and phosphorus levels. Idiopathic calcification lacks underlying tissue damage or abnormal laboratory values. Iatrogenic calcification was triggered by calcium or phosphate-containing substances. Calciphylaxis involves vessel calcification and is linked to chronic renal failure and dialysis. A 19-year-old female presented with pain and swelling on her left great toe plantar aspect, diagnosed as unilateral idiopathic calcinosis cutis. A comprehensive diagnostic approach, including histopathological, radiological, and blood investigations, is crucial for effective management. The study aimed to highlight idiopathic cutaneous calcinosis, emphasizing its accurate diagnosis through clinical, pathological, and metabolic correlation. Surgical excision offers a complete cure for this rare condition, leading to an excellent prognosis.

Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy: A case report

BACKGROUND Refractory secondary hyperparathyroidism (SHPT) is a common complication observed in patients with end-stage renal disease and can result in ectopic calcification. Metastatic calcification involving the heart valves and the conduction system can easily lead to arrhythmias, including atrioventricular block. This case report describes a maintenance hemodialysis patient with refractory SHPT resulting in a complete atrioventricular block (CAVB), which was eventually reversed to a first-degree atrioventricular block. CASE SUMMARY We present the case of a 31-year-old Asian female who was receiving maintenance hemodialysis because of lupus nephropathy. She developed SHPT, and an electrocardiogram revealed a first-degree atrioventricular block. Then, she underwent parathyroidectomy (PTX) with autotransplantation. Unfortunately, a few years later, she developed SHPT again, and an electrocardiogram revealed a CAVB. A few years after the second PTX surgery, the calcification of the left atrium and left ventricle improved, and her CAVB was reversed. CONCLUSION This case revealed that metastatic cardiac calcification can result in complete atrioventricular blockage. Following parathyroid surgery, calcification of the cardiac conduction system improved, leading to reversal of the atrioventricular block. It is important for dialysis patients to optimize intact parathyroid hormone therapy and pay attention to calcification metastasis.

Partial primary osteoporosis maybe due to parathyroid hyperfunction caused by calcium intake insufficiency and/or vitamin D insufficiency/deficiency

Osteoporosis is a global public health problem, characterized by severe morbidity and mortality of osteoporotic fractures. Meanwhile, there is a significant global prevalence of calcium intake insufficiency and/or vitamin D insufficiency/deficiency (CVI). Long-term of CVI may result in a negative calcium balance, leading to parathyroid hyperplasia, hypertrophy and hyperfunction, causing increased secretion of parathyroid hormone (PTH) which is still within the normal range. This condition is called parathyroid hyperfunction. Parathyroid hyperfunction plays a crucial role in maintaining calcium homeostasis by increasing bone resorption and raising serum calcium levels, which is a rapid and sustained process. Osteoporosis resulting from parathyroid hyperfunction is often diagnosed as primary osteoporosis because it does not meet the criteria for hyperparathyroidism. Therefore, partial primary osteoporosis is not truly primary but rather secondary osteoporosis due to parathyroid hyperfunction caused by CVI. Early recognition and intervention for this secondary osteoporosis can effectively prevent issues such as decreased height, humpback, pain, fatigue, fracture, nephrolithiasis, metastatic vascular calcification, and abnormal calcium migration and precipitation of the whole body.

December 2023 Medical Image of the Month: Metastatic Pulmonary Calcifications in End-Stage Renal Disease

No abstract available. Manuscript truncated after 150 words. A 51-year-old African-American man with medical history of obesity (BMI 36) and hypertension was seen in pulmonary consultation for preoperative evaluation of kidney transplantation. End-Stage renal disease (ESRD) was diagnosed 7 years before evaluation secondary to resistant hypertension. The patient has been on hemodialysis since then. The patient was on carvedilol, hydralazine, losartan, and calcitriol. He had prescribed sevelamer and prednisone, but he was not taking them. His main symptoms were 3-year chronic dyspnea on exertion and mild morning cough productive of small amounts of clear sputum. He has had no chest pain, wheezes, hemoptysis, fevers, or dizziness. He had trace lower extremity edema. He worked as a forklift operator. He has had no relevant exposures and was a lifetime nonsmoker. The patient was diagnosed with cryptogenic organizing pneumonia 5 years ago and was on prednisone taper with subjective improvement of symptoms. He has not had lung function testing or …

Corneal and Coronary Calcification in Maintenance Hemodialysis: The Face Is No Index to the Heart.

Although the eyes are the main site of metastatic calcification in patients with chronic kidney disease (CKD), corneal and conjunctival calcification (CCC) is poorly evaluated in this population. Whether CCC correlates with coronary artery calcification remains unknown since studies so far have relied on methods with low sensitivity. Our objective was to test the relationship between CCC and coronary calcification based on tomography. This was a cross-sectional study that included patients on maintenance dialysis. Clinical, demographic, and biochemical data (calcium, phosphorus, parathormone, alkaline phosphatase, and 25(OH)-vitamin D) were recorded. Hyperparathyroidism was defined as parathyroid hormone (PTH) > 300 pg/mL. CCC was evaluated by anterior segment optical coherence tomography (AS-OCT), and coronary calcium scores (Agatston method) were assessed by computed tomography. We compared no/mild with moderate/severe CCC. Twenty-nine patients were included (49.6 ± 15.0 years, 62.1% female, on hemodialysis for 5.7 [2.7-9.4] years, 17.2% with diabetes mellitus, 75.9% with hyperparathyroidism). CCC was found in 82.7% of patients, with median scores of 9 (3, 14.5), ranging from 0 to 16. CCC was classified as absent/mild, moderate, and severe in 27.6%, 20.7%, and 51.7%, respectively. Coronary calcification was found in 44.8% of patients, with median scores of 11 (0, 464), varying from 0 and 6456. We found no significant correlation between coronary calcium scores and CCC (r = 0.203, p = 0.282). Hyperphosphatemia was more frequent in patients with moderate/severe CCC than in those with absent/mild CCC. We concluded that CCC was frequent in patients with CKD on dialysis and did not correlate with coronary calcium scores. Hyperphosphatemia appears to contribute to CCC. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

A review on calcinosis cutis

Calcinosis, marked by hydroxyapatite, calcium, and phosphate deposits in skin and subcutaneous tissues, is common in individuals with various physiological conditions, soft tissue ailments, and autoimmune disorders. Researchers categorize and analyze these occurrences, shedding light on their pathophysiology. They also review scientific evidence regarding non- pharmacologic and pharmacodynamic treatments. Calcinosis cutis involves the accumulation of insoluble calcium ions in the epidermis and subcutaneous tissue, classified into dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis subgroups. Dysplastic deposits result from cellular damage, while metastatic calcification stems from irregular potassium and phosphorous metabolism. Undiagnosed calcification occurs independently of tissue destruction or underlying disease. Autoimmune syndrome-induced epidermal calcification is a rare therapy-related effect. Calciphylaxis, primarily affecting the vascular system, is introduced, with disturbances in calcium and phosphorus biotransformation and congenital hypothyroidism as contributing factors.

A Review on Calcinosis cutis

Calcinosis (hydroxyapatite but also calcium and phosphate particle depositions) inside the matrix proteins of both the skin and subcutaneous stroma is just a regularly attended personification like pediatric and adult immune-mediated chronic inflammatory pathogens, particularly system-wide patients with multiple, physiological conditions, mingled soft tissue illness, as well as autoimmune disorder providing the ability. Listed here, researchers overview classifying like mainly characterized, illustrate processes which may make a contribution towards the pathophysiologic like mainly characterized, but also sum up this same scientific proof trying to evaluate non - non-pharmacologic as well as pharmacodynamic intervention and prevention again for remedy like mainly characterized. calcinosis cutis has been best described even by the accumulation of irresolvable calcium ions within the epidermis as well as subcutaneous. These same symptoms seem to be kept separate into 5 subgroups: dystrophic calcification, metastatic calcification, idiopathic calcification, iatrogenic calcification, as well as calciphylaxis. dysplastic calcium deposits would seem because of municipalities' cellular damage as well as the regular calcium and phosphorus layers throughout the plasma. Distant metastasis calcified seems to be best described by such irregular potassium as well as phosphorous various metabolic, resulting in this same formation of calcium through skin lesions as well as subcutaneous. Undiagnosed calcified takes place without even any subcutaneous tissue destruction as well as a particular disease. Epidermis calcified throughout autoimmune mainly characterized syndrome is a rare is indeed a secondary effect like therapeutic. Calciphylaxis introduced for container ship calcium deposits primarily affects the vascular system of both the dermal layer as well as subcutaneous adipose. Disruptions through calcium and phosphorus biotransformation as well as congenital hypothyroidism can indeed be recognized.

Neurogenic, Fibrous and Histiocytic Tumors of the Choroid

This review details the characteristic clinical features, diagnostic approaches, treatment and prognosis of rare tumors of choroidal tissue. The aim is to help differentiate these rare tumors from sometimes clinically similar conditions such as amelanotic choroidal melanoma and nevus, metastatic choroidal carcinoma, metastatic and dystrophic intraocular calcification. Schwannomas are benign encapsulated tumors and may present as an isolated lesion or may be associated with neurofibromatosis. They appear as yellow-white lesions on fundus examination and may be confused with amelanotic melanoma. Schwannomas can be observed without any intervention because they are benign and grow slowly. Treatment options include transscleral resection and photodynamic therapy (PDT).

SAT214 A Rare Case Of Biopsy-proven Non-uremic Calciphylaxis In A Patient With Secondary Hyperparathyroidism

Abstract Disclosure: U.A. Ogar: None. A.G. Olafimihan: None. I. Asemota: None. E. Krishnaraju: None. A. Okafor: None. Introduction: Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare, lethal, metastatic calcification involving cutaneous microvasculature that presents as painful necrotic skin lesions. It typically occurs in patients with end-stage kidney disease (ESKD), renal transplant, or acute kidney injury requiring renal replacement therapy. Calciphylaxis occurring without these comorbidities is termed non-uremic calciphylaxis (NUC), which is rarer. NUC’s etiology is unclear but it has been associated with hyperparathyroidism, malignancies, alcohol liver disease, and connective tissue disorders. There are only a few reported cases of biopsy-proven NUC in patients with secondary hyperparathyroidism, as in our patient. Clinical Case: A 63-year-old female with a history of COPD on home oxygen therapy, smoking, and alcohol use disorder presented with a four-day history of severe, painful, purplish left thigh rash. She had no recent trauma or insect bite. Her physical exam showed a large (6x10 cm), tender, distal anterior left thigh bruise. Laboratory findings were significant for elevated creatine of 4.3 mg/dL from a normal baseline creatinine (0.6 mg/dL), normal serum corrected calcium (10.1 mg/dL) and elevated phosphate (4.7mg/dL). Three days following her admission, the skin lesion had progressed into multiple brown coalescing bullae with central ulceration, collarette, surrounding erythema, warmth, and induration. Due to concern for possible skin and soft tissue infection, empiric vancomycin therapy was started. However, the overall clinical picture was not convincing of an infection, necessitating consultation with the Dermatology team. A skin biopsy was recommended, and this was diagnostic of calciphylaxis. Further testing revealed hyperparathyroidism (202pg/ml), low 25 hydroxy Vitamin D (12ng/ml), and negative autoimmune and thrombophilia workup. Her treatment plan included wound care with debridement, analgesia, and interdisciplinary clinic follow-up. During outpatient follow-up, her wound was seen to be slowly healing with daily wound dressing, and her elevated serum creatinine had resolved. Conclusion: NUC has a high mortality rate (52%) and requires a high index of clinical suspicion to ensure prompt diagnosis and initiation of treatment. Differential diagnoses include atherosclerotic vascular disease, vasculitis, hypercoagulable disorders, and cellulitis as in our patient. Skin biopsy is diagnostic. Aggressive wound care and analgesia are pivotal to treatment, in addition to addressing underlying precipitating conditions. Other treatment options like sodium thiosulphate exist but with uncertain outcomes. Efforts geared at definitive therapeutic modalities are needed. Presentation: Saturday, June 17, 2023

Patient With Metastatic Airway Calcification and Hypercalcemia Due to Secondary Hyperparathyroidism.

Diaz-Churion, Fabiana MD*; Yu Lee-Mateus, Alejandra MD*; Mirzan, Haares MD*; Khoor, Andras MD, PhD†; Abia-Trujillo, David MD, MB*; Fernandez-Bussy, Sebastian MD* Author Information

Removal of calciprotein particles from the blood using an adsorption column improves prognosis of hemodialysis miniature pigs

Hyperphosphatemia is a major risk for poor prognosis in patients with end-stage renal disease. However, the molecular mechanism behind this link remains elusive. We and others have demonstrated that serum phosphorus levels correlate positively with circulating levels of calciprotein particles (CPPs). CPPs are colloidal mineral-protein complexes containing insoluble calcium-phosphate precipitates and have been reported to induce calcification in cultured vascular smooth muscle cells and inflammatory responses in cultured macrophages. Hence, we hypothesize that CPPs may be responsible for disorders associated with hyperphosphatemia. Using hyperphosphatemic miniature pigs receiving hemodialysis, here we show that removal of CPPs from the blood with a newly developed CPP adsorption column improves survival and alleviates complications including coronary artery calcification, vascular endothelial dysfunction, metastatic pulmonary calcification, left ventricular hypertrophy, and chronic inflammation. The present study identifies CPPs as an effective therapeutic target and justifies clinical trials to determine whether the CPP adsorption column may be useful as a medical device for improving clinical outcomes of hemodialysis patients.

Metastatic Pulmonary Calcification: Single-Center Review of Typical and Atypical Imaging Features.

The purpose of this study is to bring attention to an atypical form of metastatic pulmonary calcification, which is conventionally described as a metabolic process with upper lobe predominance in patients with a specific clinical history, which has not been reported as a distinct entity. Patients with metastatic pulmonary calcification (MPC) were first identified with mPower keyword search, including MPC or metastatic calcifications on computed tomography chest radiological reports. Patients were then filtered on likelihood of MPC based off imaging reports. Images were then reviewed by three senior radiologists for pertinent characteristics such as location of MPC, degree of calcifications and pleural effusions. Based on the predominant location of MPC, cases were labeled as either typical or atypical. Clinical and imaging characteristics relevant to MPC were noted and compared across typical and atypical cases. In our study, we describe 25 patients with MPC, 13 defined as typical MPC and 12 with atypical MPC. Through consensus of senior radiologists, MPC was deemed to be mild (52%), moderate (44%), or severe (4%). Twenty-three patients (92%) had underlying renal disease including 21 requiring dialysis at the time of diagnosis. Outside of age at diagnosis, there was no significant clinical difference between the two groups. Evaluation of imaging characteristics (average HU attenuation, 267; range, 186-295), pattern and distribution of calcification, and clinical history strongly supported a diagnosis of atypical MPC. This study presents several cases of lower lobe subpleural MPC associated with pleural effusions, which has not been reported as a distinct entity, despite comprising a significant portion of MPC cases at our institution.

Effect of metastatic calcification on complication rate and survival in 74 renal transplant cats (1998-2020).

To report the incidence of metastatic calcification in cats with renal failure presenting for renal transplantation, and to determine if metastatic calcification detected prior to renal transplantation is associated with complication rates and patient survival. Retrospective case series. Seventy-four cats. In imaging studies, 178 feline renal transplant recipients from 1998 to 2020 were evaluated for metastatic calcification. Demographic, clinicopathological data, intraoperative complications, postoperative complications, need for hemodialysis, and survival times were recorded. Exclusion criteria were cats lacking imaging reports and cats with gastric, renal, or tracheal/bronchial calcification alone. Univariable and multivariable analyses were performed to determine variables that were independently associated with survival. Kaplan-Meier analysis was used to generate survival plots and estimate median survival times with a 95% confidence interval (CI). Seventy four of 178 cats met the inclusion criteria. Fifteen of 74 (20.3%) cats had metastatic calcification prior to renal transplantation. Twelve of 74 (16.2%) cats developed calcification following transplantation, and 47 of 74 (63.5%) cats had no calcification during the study period. Median follow-up time was 472 days, with a range of 0-1825 days. Cats with pretransplant calcification had shorter median survival times (147 days) than cats without calcification (646 days) (p = .0013). Metastatic calcification pretransplant was associated with an increased risk of death by 240% (95% CI, 1.22-4.71). Metastatic calcification in renal transplant cats is a negative prognostic indicator and is associated with decreased survival times. These findings may help guide therapeutic recommendations and owner expectations in cats undergoing renal transplantation.

Effects of Dietary Vitamin D3 Over-Supplementation on Broiler Chickens' Health; Clinicopathological and Immunohistochemical Characteristics

Introduction: Vitamin D3 is used as a supplement in the feeds of livestock, pets, and human infants. However, the presence of excessive Vitamin D3 has been shown to cause toxicity in humans and animals. This study investigated the clinicopathological aspects of Vitamin D3 toxicity in broiler chickens. Materials and methods: The median lethal dose (LD50) of Vitamin D3 was estimated by the up-and-down method. To determine long term (21 days) toxic effects of oral Vitamin D3 supplementation, 90 (14-day-old) IBL-80 unsexed chicks were randomly divided into three groups as group A (control, received basal diet), B (basal diet + Vitamin D3 at 16.67 mg/kg body weight daily), and C (basal diet + Vitamin D3 at 33.33 mg/kg body weight daily). Results: The findings indicated that broiler chickens tolerated a single oral dose of Vitamin D3 up to 550 mg/kg body weight (22,000,000 IU/kg) without mortality. The results of long-term (21 days) oral supplementation of divided doses of Vitamin D3 in broiler chickens (groups B and C) showed progressive emaciation, elevated hemoglobin, hypercalcemia, hypophosphatemia, and increased alkaline phosphatase activity. At necropsy, pale liver and kidneys, congestion and hardening of lungs, mild congestion in the brain, and soft bones were observed in Vitamin D3 treated chicks (groups B and C). Microscopically, degeneration and metastatic calcification in lung parenchyma and peribronchiolar epithelium, coagulative necrosis and calcification in kidneys, and calcification with fibroplasia in proventriculus was detected. Lungs and kidneys showed a significant difference in calcification score between groups B and C. Broiler chickens from Vitamin D3 treated groups (B and C) showed strong immunohistochemical expression of Calbindin D28K in the intestine and kidneys but weak expression in the lungs. Conclusion: This study demonstrates that broiler chicks can tolerate very high levels of a single oral dose of Vitamin D3. Toxic effects of prolonged exposure to Vitamin D3 are due to over-expression of Calbindin D28k in the intestine and kidneys, disturbing the calcium and phosphorous homeostasis and leading to metastatic calcification of vital organs. This study supports that prolonged over-supplementation of Vitamin D3 causes toxic effects; hence, appropriate dietary Vitamin D3 supplementation limits should be set.

Subcutaneous Fat Necrosis of the Newborn After Whole-Body Cooling for Birth Asphyxia

Therapeutic hypothermia (TH) is a challenging treatment for a neonate who suffers from hypoxic-ischemic encephalopathy. It has been shown to improve neurodevelopmental outcomes and survival ininfants with moderate-to-severe hypoxic-ischemic encephalopathy.However, it has severe adverse effects such as subcutaneous fat necrosis (SCFN). SCFN is a rare disorder that affects term neonates. It is a self-limited disorder but can have severe complications such as hypercalcemia, hypoglycemia, metastatic calcifications, and thrombocytopenia. In this case report, we present a term newborn who developed SCFN after whole-body cooling.

SOFT TISSUE CALCIFICATIONS : ASERIES OF FOUR CASES

Heterotrophic calcificationsare pathologic calcifications of the soft tissue regiondue to any chronic inflammatory cause(dystrophic calcification) or by hypercalcemic states in the body(metastatic calcification) or due to any idiopathic cause. It is usually detected as an incidental finding and rarely appears symptomatic. Here we are presenting fewcase reports of patients with soft tissue calcifications that reported to the department of Oral Medicine andRadiology.