Tumoral Calcinosis of the Hand

WOS: 000260854800024PubMed ID: 19226078Tumoral calcinosis is characterized by the deposition of calcium phosphate in periarticular soft tissues and mainly appears around large joints. The involvement of the hand is extremely rare. This article describes a 43-year old man presenting with a history of 13-year-long periodic attacks of severe pain, swelling, and redness over the dorsal aspect of the third metacarpophalangeal joint of his right hand. Twelve years before he had undergone an unsuccessful surgical excision of the mass. There was neither a history of systemic disease nor a related family history. Physical examination displayed swelling and slight tenderness over the dorsal aspect of the third metacarpophalangeal joint of his right hand. The overlying skin was intact. The mobility of adjacent metacarpophalangeal joint was unlimited. Plain radiographs showed multiple round to oval, well-demarcated masses of calcifications located in the periarticular Soft tissue of the third metacarpophalangeal joint. An osteolysis of ulnar aspects of subarticular parts of both third metatarsal and proximal phalanx has also appeared subsequently in Course. Computed tomography showed calcitic focci in the soft tissue around the erosive lesions. Laboratory tests that included the erythrocyte sedimentation rates, cell counts, electrolytes (serum calcium and phosphate), and uric acid were all within the normal range. The patient had no evidence of any underlying disease such as a metabolic or endocrine abnormality or connective tissue disease. He was treated by the surgical excision of the mass. Excised material consisted of precipitation of calcium salts without any evidence of gouty tophus and diagnosed histopathologically as calcinosis. At 4-year follow-up, the patient was pain free without evidence of recurrence. Tumoral calcinosis, a condition with unknown etiology, should be considered in the differential diagnosis of painful masses in the hand. Its cure is possible with early and complete surgical excision. Acute calcific deposits, tophaceus gout, and pseudogout should be taken into account in the differential diagnosis