Hip Pelvis.  2014 Mar;26(1):55-61. 10.5371/hp.2014.26.1.55.

Uremic Tumoral Calcinosis around the Hip Joint in a Patient on Hemodialysis

• Suh YS
• Choi HS
• Chun DI
• Choi SW
• Kim YB
• Chang BW
• Seo GW

• KMID: 2054164
• DOI: http://doi.org/10.5371/hp.2014.26.1.55

Abstract

The term tumoral calcinosis in used to describe the deposition of nodular calcareous masses in the soft tissue around large joints, such as the hips, shoulders, and elbows. Although the cause has not yet been clearly determined, according to the hypothesis, failure of phosphorus metabolism in the proximal tubule in kidney, chronic renal disease and hyperparathyroidism may cause tumoral calcinosis. No cases of tumoral calcinosis treated with surgical resection in chronic renal failure patients on hemodialysis, so called uremic tumoral calcinosis, have been reported in Korea. The authors experienced the case of a 57-year-old woman with chronic kidney disease on hemodialysis who presented with a mass around the hip. We made a diagnosis using plain radiographs, magnetic resonance imaging, and computed tomography of tumoral calcinosis, and treated the patient successfully with surgical resection. We report on a case of uremic tumoral calcinosis with a review of the literature.

Keyword

Tumoral calcinosis; Hip; Hemodialysis

MeSH Terms

Calcinosis*
Diagnosis
Elbow
Female
Hip
Hip Joint*
Humans
Hyperparathyroidism
Joints
Kidney
Kidney Failure, Chronic
Korea
Magnetic Resonance Imaging
Metabolism
Middle Aged
Phosphorus
Renal Dialysis*
Renal Insufficiency, Chronic
Shoulder
Phosphorus

Figure

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  Fig. 1 Anterior view of the pelvis shows huge bulging mass (arrows) located around the right proximal hip. There were no redness or skin lesion around the mass.

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  Fig. 2 Plain pelvic AP and lateral radiographs shows large radioopaque lesion at soft tissue around hip joint consisted of multiple round calcified masses.

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  Fig. 3 (A) Coronal non-contrast T1-weighted image through the pelvis demonstrates 6.7×6.6×13.4 cm sized multiple conglomerated low signal mass around right iliotibial band, vastus lateralis and iliopsoas muscle. There was no definite enhancement in the lesion. (B) Coronal non-contrast T2-weighted image demonstrates dark signal mass. (C) Coronal T1-weighted enhance image shows no definite enhancement in the lesion.

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  Fig. 4 Three-dimensional computed tomography shows accumulation of multinodular calcareous deposits around right hip joint.

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  Fig. 5 (A) Intraoperative photographs shows protruded mass which is partially adherent to the adjacent muscles. (B) The mass contained highly concentrated whitish milk-like fluid.

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  Fig. 6 (A) The specimen was divided into two major chunks. And the size of each were 9.0×6.0×3.0 cm and 5.5×2.5×2.0 cm. (B) Bisection plane of the specimen shows yellow and white of the solid component with surrounding liquid component.

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  Fig. 7 Postoperative plain pelvis AP and lateral radiographs shows the clearance of calcified masses around the hip joint.

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  Fig. 8 (A) The lobules are separated by fibrous septa, with a lining of mixed fibrous and inflammatory tissue with surrounding soft-tissue fibrosis and inflammatory changes. (B, C) Microscopic pictures show amorphous eosinophilic material and many macrophages (hematoxylin & eosin stain; B, ×100; C, ×400).

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