Kinza Abdul Hye  ( Department of Nuclear Medicine, Institute of Nuclear Medicine and Oncology, INMOL, New Campus Road, Lahore. Pakistan )
Muhammad Numair Younis  ( Department of Nuclear Medicine, Institute of Nuclear Medicine and Oncology, INMOL, New Campus Road, Lahore. Pakistan )

Renal tumoural calcinosis is rare, but the incidence is rising with increasing life expectancy due to dialysis. Whole body skeletal scintigraphy with 99mTc- MDP is a sensitive method to detect sites of osseous involvement. We share an interesting image of the bone scan, in a patient with extensive renal tumoural calcinosis.

 

Keywords: End Stage Renal Disease, Tumoural calcinosis, bone scan

 

DOI: https://doi.org/10.47391/JPMA.23-30

 

A 45 years old male with chronic kidney disease and on dialysis for the last 5 years,  progressively developed multiple swellings involving dorsum of left hand, index finger of right hand, right wrist joint (more on ulnar side) and around left knee joint extending up to the midthigh. These swellings were soft in consistency, multilobulated, mobile and variable in size ranging from 2x3 to 4x4 cm. Patient was referred for skeletal scintigraphy after blood investigations and plain radiography. All investigations were suggesting the calcification in soft tissues without any bone pathology and later confirmed by histopathology (Figure).

 

 

Soft-tissue calcification by deposition of hydroxyapatite crystals can be localized or multifocal, and small or extensive representing a tumoural mass known as tumoural calcinosis.¹ Tumoural calcinosis, an uncommon late sequel of end-stage renal disease is characterised by painful periarticular lesions.² Plain X-ray is often sufficient, but complementary CT (Computed Tomography) or MRI (Magnetic Resonance Imaging) imaging of the involved region may be necessary for structural details.¹ Skeletal scintigraphy provides a complete survey of the skeleton, thus demonstrating all the disease sites in a single study,³  as in our case multiple sites were identified.

 

References

 

1.      Ibrahim Montasser D, Issouani J, Hassani M, Kabbaj D. Tumoral calcinosis: Diffuse multifocal form in hemodialysis patients. Two case reports. Orthop Traumatol Surg Res. 2017;103:815-820.

2.      Westermann L, Isbell LK, Breitenfeldt MK, Arnold F, Röthele E, Schneider J, Widmeier E. Recuperation of severe tumoral calcinosis in a dialysis patient: A case report. World J Clin Cases. 2019;7:4004-4010.

3.      Pal R, Parihar AS, Bhadada SK, Mittal BR. Hyperphosphatemic Tumoral Calcinosis: A Classical Clinico-Radio-Scintigraphic Presentation. Indian J Nucl Med. 2021;36:76-77.