Case
A 4-year-old female presented to plastic and reconstructive surgery
clinic with a slowly enlarging mass on the dorsal aspect of the right
wrist. The mass was first noted by her parents 2 months ago. It was
associated with pain and discomfort, however, there was no functional
limitation. Parents denied history of trauma, lesions in other areas of
the body, as well as family or medical history of note.
On hand examination, a solitary mass appeared on the dorsal aspect of
the right wrist, medial to the lister’s tubercle, measuring 1.5 x 1.5
cm. It was a firm, tender mass with intact overlying skin. Range of
motion of the wrist was within normal limit. The mass appeared to move
with the extension of the right index finger. Sensation was intact and
pulses were palpable.
Ultrasound examination revealed a swelling on the dorsal aspect of the
wrist measuring 15 x 10 x 5 mm. The swelling was well-defined,
multilobulated and mildly echogenic with some vascularity. The swelling
was lying within the fourth extensor tendon compartment at the radial
aspect and is closely opposed to the extensor indicis proprius tendonFigure 1. Therefore, the working diagnosis was a giant
cell tumor of the tendon sheath. No further imaging was performed.
In the operating theatre, exploration of the wrist revealed a mass
attached to the extensor indicis proprius tendon. The mass was excised
completely and sent for histopathological review. Grossly, the mass
consisted of greyish yellow soft tissue, measuring 1.5 x 1 x 0.7 cm.
Microscopically, Sections show circumscribed variably sized multinodules
separated by fibrous speta; forming lobules contain amorphous granular
calcific material with a few scattered psammomatous bodies, and rimmed
by histocytes including multinucleated histocytes giant cells. There is
no evidence of crystals noted on regular and polarised light
microscopic examination Figure 2, 3. The
histopathological report was compatible with tumoral calcinosis.
Consequently, the necessary laboratory investigations were ordered. The
results of serum phosphate, serum calcium, vitamin D, parathyroid
hormone, renal function test, uric acid and c-reactive protein were
within normal limits. Anti-nuclear antibodies were not detected. Thus, a
diagnosis of idiopathic tumoral calcinosis was made.