Submucosal Calcification Research Articles

Amyloidosis: Modern Cross-sectional Imaging.

Amyloidosis is a rare diverse condition caused by the pathologic extracellular deposition of abnormal insoluble proteins throughout the body. It may exist as a primary disease or, more commonly, may be secondary to a wide variety of pathologic processes ranging from chronic infection or inflammation to malignancy. Hereditary forms also exist. On the basis of the structure of the protein deposits, more than two dozen subtypes of amyloidosis have been described. A single organ or multiple organ systems may be affected. The radiologic manifestations of amyloidosis are varied and often nonspecific, making amyloidosis a diagnostic challenge for the radiologist. In the chest, the lungs, mediastinum, pleura, and heart may be involved. Lung involvement may manifest as diffuse reticulonodular interstitial thickening, consolidations, or solitary or multiple parenchymal nodules that may calcify, cavitate, and slowly enlarge. Pleural involvement most commonly manifests as pleural effusions. Tracheobronchial involvement may exhibit concentric airway thickening, mural and intraluminal nodules, submucosal calcification, and airway obstruction. Mediastinal and hilar lymph nodes may enlarge and frequently calcify. At cardiac magnetic resonance (MR) imaging, the left ventricular wall is typically thickened, with associated diastolic dysfunction. Delayed contrast material-enhanced cardiac MR imaging typically shows global transmural or subendocardial enhancement. The pathophysiology, classification, treatment, and prognosis of amyloidosis are reviewed, followed by case examples of the appearance of thoracic and cardiac amyloidosis on chest radiographs, computed tomographic (CT) images, and cardiac MR images.

617 EROSION OF CALCIFIED MARCROPLASTIQUE: A LATE COMPLICATION FOLLOWING INJECTION FOR VESICO-URETERAL REFLUX

You have accessJournal of UrologyPediatrics: Imaging (Genital & Urinary Tract)/Infections and Vesicoureteral Reflux1 Apr 2012617 EROSION OF CALCIFIED MARCROPLASTIQUE: A LATE COMPLICATION FOLLOWING INJECTION FOR VESICO-URETERAL REFLUX Justin Lee, Bryce Weber, Victor Figueroa, Rodrigo Romao, Joao L. Pippi Salle, Darius Bagli, Antoine Khoury, and Armando Lorenzo Justin LeeJustin Lee Toronto, Canada More articles by this author , Bryce WeberBryce Weber Toronto, Canada More articles by this author , Victor FigueroaVictor Figueroa Toronto, Canada More articles by this author , Rodrigo RomaoRodrigo Romao Toronto, Canada More articles by this author , Joao L. Pippi SalleJoao L. Pippi Salle Toronto, Canada More articles by this author , Darius BagliDarius Bagli Toronto, Canada More articles by this author , Antoine KhouryAntoine Khoury Orange, CA More articles by this author , and Armando LorenzoArmando Lorenzo Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.695AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Polydimethylsiloxane (Macroplastique®) gained acceptance in many parts of the world as an injectable bulking agent for correction of vesicoureteral reflux (VUR). Although regarded as safe and effective, the long-term consequences of such intervention remain largely unknown. Herein we report one important complication detected during follow-up in a single institution series. METHODS A total of 274 children underwent subureteric injection between 1998 and 2004, being regularly monitored since. Of these, all patients that have presented with submucosal calcification in the prior area of injection have been prospectively captured. Clinical features and data on patient characteristics were obtained by chart review. RESULTS Four patients ages 10, 13, 13 and 15 developed submucosal bladder calcifications 5, 7, 9, and 10 years following the initial injection for VUR. In all, the intervention was uneventful and no clinical or sonographic abnormalities were detected after the procedure. Patients subsequently presented with worsening hydronephrosis, hematuria and irritative lower urinary tract symptoms. On ultrasonography and X-ray we discovered calcifications at the site of prior injection. At time of surgery the calcified material was extracted endoscopically after unroofing the overlying eroded mucosa or resected along with its adjacent fibrotic pseudo-capsule through cystotomy. To date no recurrences have been detected and none of the patients have undergone ureteral reimplantation. CONCLUSIONS This experience calls attention to a potentially important yet rare complication that can be encountered following endoscopic injection with Macroplastique®. Monitoring of these patients appears warranted as long-term issues with new injectable materials remains largely unknown. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e251 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Lee Toronto, Canada More articles by this author Bryce Weber Toronto, Canada More articles by this author Victor Figueroa Toronto, Canada More articles by this author Rodrigo Romao Toronto, Canada More articles by this author Joao L. Pippi Salle Toronto, Canada More articles by this author Darius Bagli Toronto, Canada More articles by this author Antoine Khoury Orange, CA More articles by this author Armando Lorenzo Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Localized Nasopharyngeal Amyloidosis Causing Bilateral Nasolacrimal Duct Obstruction

A 62-year-old woman with a history of localized nasopharyngeal amyloidosis presented with bilateral complete nasolacrimal duct obstruction and 2 previous episodes of right dacryocystitis. Workup for systemic involvement was negative. Pathology was confirmed at the time of previous endonasal sinus surgery, showing submucosal amorphous deposition of Congo Red-positive material with apple-green birefringence. Computed tomography revealed extensive submucosal calcifications in the head and neck region, including bilateral nasolacrimal ducts. Localized amyloidosis is rare and most commonly involves the head and neck region. There is a previously reported case of nasolacrimal obstruction secondary to amyloidosis focal only to the nasolacrimal system, but we believe this to be the first report of localized nasopharyngeal amyloidosis to involve the nasolacrimal system.

Metastatic calcification involving the true vocal cord

Metastatic calcification (MC) commonly results secondary to phosphorus and calcium dysregulation in end-stage renal disease (ESRD). Only once before has MC been reported to involve a true vocal cord. A 35-year-old man with ESRD and secondary hyperparathyroidism was evaluated for hoarseness. Three years ago, he underwent a total parathyroidectomy with parathyroid autograft to the forearm. Simultaneously, he had a left lobe thyroidectomy that displayed a papillary thyroid carcinoma. Since that time, he continued to have hyperphosphatemia and hypocalcemia. Laryngoscopy displayed a small papillomatous lesion on the right true vocal cord. He underwent excision of the vocal cord lesion; histologic examination demonstrated benign squamous epithelium with extensive submucosal calcification. In patients with ESRD with secondary dysregulation of serum phosphorus to calcium level balance, MC may involve variable anatomical locations, including the true vocal cords. Regarding histologic findings, pathologists must consider malignancies associated with calcification, mimicking a benign process.

Progressive Pulmonary Calcification after Successful Renal Transplantation

In 2005, a 46-year-old woman consulted our department for an evaluation of a chest radiographic abnormality. She had undergone a successful living renal transplantation in 1999 after being treated by dialysis for four years. A chest computed tomographic scan revealed progressive bilateral fluffy, poorly defined small nodules and the bronchoscopic study revealed a unique linear and nodular lesion pattern. Based on the findings of these modalities, we confirmed the diagnosis of metaplastic pulmonary calcification. This is the first report of these bronchoscopic findings and submucosal calcification in a case of metastatic pulmonary calcification.

Symptomatic Calcification of Subureteral Collagen Ten Years After Injection

Bovine glutaraldehyde cross-linked collagen is an injectable bulking agent used to treat urinary incontinence and vesicoureteral reflux. A 16-year-old girl had previously undergone left subureteral injection of collagen at the age of 6 years. She presented to our clinic after passing a 7-mm calcification with a history of hematuria and intermittent back pain. Computed tomography showed two hyperdense foci measuring 2 mm each in the region of the left ureterovesical junction that did not change on follow-up imaging. On cystoscopy, two submucosal calcifications were located medially and inferiorly to the left ureteral orifice and were removed endoscopically.

Calcification of Glutaraldehyde Cross-Linked Collagen in Bladder Neck Injections in Children With Incontinence: A Long-Term Complication

We report the incidence of calcifications developing at the bladder neck/urethra in pediatric patients treated with glutaraldehyde cross-linked collagen for urinary incontinence. We reviewed charts of patients treated with glutaraldehyde cross-linked collagen injections for urinary incontinence between 1994 and 1999. Etiology of incontinence, pertinent medical history, operative details and postoperative imaging were examined. Of 31 patients 4 (13%) had development of submucosal calcifications in the bladder neck/urethra. All 4 patients had received multiple injections of glutaraldehyde cross-linked collagen for incontinence secondary to neurogenic bladder. The calcifications were confirmed surgically. Pathology reports available for 2 of 4 patients showed chronic inflammation without dysplasia or malignant changes. Mean followup was significantly different between calcified and noncalcified cases (10.3 vs 7.2 years, p = 0.009), as was total volume of collagen injected (21 vs 12 cc, p = 0.012). Mean time to diagnosis of calcifications was 8.8 years (range 7 to 11) after first injection. A total of 24 patients without calcification underwent bladder imaging at a mean of 6.8 years (+/-2.2) after glutaraldehyde cross-linked collagen injection, which was not significantly different than the time to diagnosis (p = 0.089). The number of injections was not significantly different between the 2 groups (p = 0.426). Of our patients 13% had development of calcifications at the site of prior glutaraldehyde cross-linked collagen injections for incontinence. These calcifications were surrounded by chronic inflammation. Patients who have undergone glutaraldehyde cross-linked collagen injections may benefit from long-term followup with bladder imaging to detect and follow calcifications at prior injection sites.

Spontaneous lesions in the respiratory epithelium of the Syrian golden hamster as seen by scanning electron microscopy

The respiratory epithelium of 8, 12.5 and 17.5-month-old Syrian golden hamsters was investigated by scanning electron microscopy (SEM) and routine light microscopy (LM) of paraplast sections. In selected cases, SEM-specimens were embedded in Epon after SEM evaluation. The samples were cut in semithin sections and examined by light microscopy. The density of ciliated cells in the respiratory epithelium differs from hamster to hamster. Care must, therefore, be taken when diagnosing simple metaplasia by SEM alone unless a sufficient number of damaged cilia are present. Only 1 animal (8 months old) exhibited squamous metaplasia of the tracheal mucosa. However, surface polymorphism resembling squamous metaplasia was seen in almost every specimen. The polymorphism was caused by either submucosal calcifications or by cystic changes of hypertrophic submucosal glands. In addition, variously formed aggregations of mucus were seen protruding from duct openings of hypertrophic submucosal glands. To avoid false positive or negative diagnosis which can occur when screening is done by SEM alone, light-microscopical examination of sections cut from SEM identified lesions appears necessary.

Experimental tympanosclerosis following infection with Streptococcus pyogenes and vitamin D3 intoxication

A rat animal model was used to study the ultrastructure of submucosal calcifications induced in the middle ear following inoculation with Streptococcus pyogenes and high doses of parenteral vitamin D3. The morphological changes present in affected animals resembled the classical picture of tympanosclerosis. While calcification occurred about bacterial remnants and myelin structures, the most important calcification centers were lysosomal and non-lysosomal matrix vesicles in the extracellular spaces. These formed band-like calcifications close to the basal membrane without affecting the epithelial layer. This animal model offers the possibility of studying the effect of various therapeutic regimens in the treatment of the dynamic tympanosclerotic process.

Primary amyloidosis of urinary bladder and ureter: Cause of mural calcification

Primary amyloidosis is seen in the absence of predisposing disease. It may affect most organs in the body, including the collecting system of the urinary tract. Submucosal calcifications have been described in the renal pelvis and may be pathognomonic for primary amyloidosis of the renal pelvis. We have been able to demonstrate similar Submucosal calcifications in the ureter and bladder. The differential diagnosis of Submucosal calcification of the distal ureter and bladder must include bilharziasis and tuberculosis. With the recognition of submucosal calcifications, diagnosis of the underlying disease may be readily made. An illustrative case is presented.

Primary amyloidosis of the renal pelvis.

AMYLOID deposits restricted in distribution to the renal pelves have seldom been described in the literature.1 2 3 4 Recently, we encountered a patient with this unusual condition. The case is presented here to call attention to a distinctive and perhaps unique radiographic finding in primary amyloidosis of the renal pelvis: linear submucosal calcification outlining the pelvocalyceal system of the kidney.Case ReportA 39-year-old man was admitted to the hospital in March, 1969, for evaluation of progressive and undiagnosed renal disease of 2 years' duration. Complete physical examination and urinalysis had been within normal limits 4 years previously.In February, 1967, he . . .