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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 1  |  Page : 105-106
Tumoral Calcinosis of the Elbow in a Long-Term Hemodialysis Patient


Department of Nephrology and Dialysis, Hassani Hospital Center, 62000 Nador, Morocco

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How to cite this article:
Tarrass F, Benjelloun M. Tumoral Calcinosis of the Elbow in a Long-Term Hemodialysis Patient. Saudi J Kidney Dis Transpl 2008;19:105-6

How to cite this URL:
Tarrass F, Benjelloun M. Tumoral Calcinosis of the Elbow in a Long-Term Hemodialysis Patient. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2019 Dec 10];19:105-6. Available from: http://www.sjkdt.org/text.asp?2008/19/1/105/37446
To the Editor:

Tumoral calcinosis is a rare clinical and histopathologic syndrome characterized by calcium salt deposits in periarticular soft tissue. [1] This report describes the occurrence of this entity in the elbow of a patient on long-term hemodialysis (HD) therapy.

A 23-year-old female patient on HD was referred to our center with lesions around the elbow joints which discharged calcified mate­rial. She had been diagnosed to have end-stage renal disease (ESRD) due to chronic glome­rulonephritis nine-years earlier. Her symp­toms started as migrating polyarthralgia with minimal swelling relieved by non-steroidal anti-inflammatory drugs. Five-months later, she developed swelling of the back of the right elbow. Skeletal survey showed extensive arterial calcification with periarticular calci­fication of right elbow [Figure - 1]. Fine needle aspiration of the hand nodules and the lump yielded thick milky white material, which under the microscope demonstrated some granular and crystalloid eosinophilic material with significant calcification and no viable cells. The clinical presentation and histolo­gical findings were characteristic of tumoral calcinosis. Laboratory investigations showed hypercalcemia (2.66 mmol/L), hyperphos­phatemia (2.53 mmol/L), elevated alkaline phosphatase (1872 IU/L), and a grossly ele­vated parathormone (PTH) levels (1759 pg/ml). Ultrasound of the parathyroid gland did not reveal any adenoma. The patient underwent subtotal parathyroidectomy with preservation of part of a single parathyroid gland. Post-operatively her serum calcium level came down to 1.2 mmol/L and was managed by administration of intravenous calcium.

Tumoral calcinosis is an uncommon occurrence in patients with chronic renal failure who are undergoing dialysis. [1] Lesions usually occur in the setting of hyper­parathyroidism and elevated serum calcium x phosphate product. The use of active vitamin D and calcium-containing phosphate binders is also associated with this entity. [2],[3] Treatment involves correction of the calcium x phosphate product with the use of oral phosphate binders, ensuring dialysis adequacy, and, in some cases resection of the mass and parathyroidectomy. Successful renal transplantation has also been reported to be associated with clinical improvement. [3],[4],[5]

 
   References Top

1.Harwood CA, Cook MG, Mortimer PS. Tumoral calcinosis: An unusual cause of cutaneous calcification. Clin Exp Dermatol 1996;21:163-6.  Back to cited text no. 1  [PUBMED]  
2.Tezelman S, Siperstein AE, Duh QY, Clark OH. Tumoral calcinosis. Controversies in the etiology and alternatives in the treatment. Arch Surg 1993;128:737-44.  Back to cited text no. 2    
3.Pecovnik-Balon B, Kramberger S. Tumoral calcinosis in patients on hemodialysis: Case report and review of the literature. Am J Nephrol 1997;17:93-5.  Back to cited text no. 3  [PUBMED]  
4.Thakur A, Hines OJ, Thakur V, Gordon HE. Tumoral calcinosis regression after subtotal parathyroidectomy: A case presentation and review of literature. Surgery 1999;126:95-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.McGregor D, Burn J, Lynn K, Robson R. Rapid resolution of tumoral calcinosis after renal transplantation. Clin Nephrol 1999; 51:4-8.  Back to cited text no. 5    

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Correspondence Address:
Faissal Tarrass
Department of Nephrology and Dialysis, Hassani Hospital Center, 62000 Nador
Morocco
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PMID: 18087136

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