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.