Sprocess characterized by the appearance of · Case Report Senthil Ponnusamy1, Suhailur Rehman2, Sayeedul Hasan Arif3, R S Chana4 ABSTRACT Background: Calcinosis cutis is a process

Case Report

1 2 3 4Senthil Ponnusamy , Suhailur Rehman , Sayeedul Hasan Arif , R S Chana

ABSTRACT

Background:

Calcinosis cutis is a process with accumulation of calcium in the dermis, forming masses anywhere

in the body. Scrotalcalcinosis is a rare benign local process. Calcinosis cutis has four major types

according to etiology. Scrotal calcinosis is mostly multiple, commonly occurs between third and

fourth decades of life. It is extremely rare in infants. This is a case report of single calcified nodule

that occurred in the scortum of an 8 month old boy. The lesion was identified by cytology and

confirmed with histology. Various sites of few infantile calcinosis have been described till now. Here

we report a very rare and first case in an infant, who presented with idiopathic calcinosis cutis in

scrotum.

Keywords: Scrotal calcinosis cutis, Infant, Idiopathic, Dystrophic.

INTRODUCTION:

crotal calcinosis is a rare benign local

process characterized by the appearance of Scalcific masses within the dermis of

scrotum. Clinically it presents with multiple,

painless, scrotal nodules in the absence of any

1systemic metabolic disorder. Although a few

infants with calcinosis cutis have been reported, to

the authors' knowledge, our aim is to report this

very rare and first case in infant with idiopathic

calcinosis cutis in scrotum presenting as single

nodule.

CASE REPORT:

We report a 8 months old child with asymptomatic

single calcified scrotal skin nodule noticed by his

Address for correspondence:

Dr Senthil P, 4-1/56A, RC Plant, Raman Nagar, Mettur Dam, Salem-636403.

Email [email protected] Ph No : 07895173210.

1Asst. Professor, Dept. of Pathology, Vinayaka Mission's Kirupananda Variyar Medical College & Hospital, Salem, Tamil Nadu. 2Senior Resident, Department of Pathology, J.N. Medical College & Hospital, A.M.U, Aligarh, Uttar Pradesh.

3Professor, Department of Pathology, J.N. Medical College & Hospital, A.M.U, Aligarh, Uttar Pradesh.4Professor, Department of Pediatric Surgery, J.N. Medical College & Hospital, A.M.U., Aligarh, Utter Pradesh.

National Journal of Basic Medical Sciences | Volume 7 | Issue 4 | 2017

Idiopathic Scrotal CalcinosisIn An Infant : Unusual Presentation

parents. On examination nodule was single on the

right side of anterior wall of scrotum, Size -

2x1.5cm, firm to hard in consistency, non-tender,

movable (Fig-1-A). No other swellings in the body.

On clinical examination pyogenic abscess or

calcinosis cutis was suspected.

FNAC showed extensive amphophilic calcified

material(Fig, 1-B),calcinosis cutis was suspected

and advised for biopsy. Wide excision of the lesion

and direct closure of the scrotum was done.

Histological examination revealed extensive

deposition of calcium in the dermis, which was

surrounded by histiocytes and an inflammatory

giant cell reaction (Fig 1-C). Calcium was

confirmed with von-kossa staining. Serum levels of

calcium and phosphate was within normal limit.

247

248National Journal of Basic Medical Sciences | Volume 7 | Issue 4 | 2017

Figure-1 : APhotograph shows single nodule, in

right side anterior wall of scrotum.

Figure-2 : BFNAC – Low power view (H & E

x50) extensive amphophilic calcified material.

Figure-3 : CH & E x 50- Microscopy low power

view shows extensive deposition of calcium in

dermis

DISCUSSION:

Idiopathic calcinosis cutis of scrotum was first 2illustrated by H.M. Lewinsky in 1883. Scrotal

calcinosis is mostly multiple and commonly occurs 1

between third and fourth decades of life. It can can 3also occur during childhood or early adulthood.

However very few studies have noted that

calcinosis cutis in infants occur at various sites 4 5 6 7

including ear, hard palate, oral cavity, left foot, 8 9leg, and skin. Although calcinosis cutis has been

reported at various sites in infants, this is indeed the

first case to be reported in an infant's scrotum.

Calcinosis cutis is classified into four major types

according to etiology: Dystrophic, Metastatic, 1 7Idiopathic and Iatrogenic. Among those

1dystrophic and idiopathic types are rare. The

pathogenesis of calcinosis cutis has not been fully

elucidated and remains controversial. The calcium

deposition can be idiopathic or in can be from pre-2

existing lesions like epidermoid cyst. Very few

studies have proposed that scrotal calcinosis

represents idiopathic calcification without any 10,11,12,13etiology. Few studies support the calcinosis

cutis is a form of dystrophic calcification arising

from the pre-existing structures like epidermal 14,15 16 17,18

cysts the hair follicle and eccrine glands

Dubey et al explained theory of dystrophic

calcification of epithelial cysts in their studies

presumed that absence of a cyst wall (40 percent),

due to late stage interventional surgery and earlier

stages may just not have been sampled. In

dystrophic calcification of epithelial cysts, the

cysts become inflamed, rupture, and calcify, with 19gradual obliteration of the cyst wall.

In our case- no pre-existing lesions were present.

Dr Senthil P, et.al : Idiopathic Scrotal Calcinosis in an infant


There was no also no preceding history like trauma

or connective tissue disorders. The excision of

scrotal calcinosis was done without recurrence in a

period of 12 months. This case is unique as this is a

rare variety of idiopathic scrotal calcinosis cutis in

an infant presenting as a single nodule.

Agrawal et al and Sherwani et al mentioned that

presence of amorphous calcium salts along with 20,21

histiocytes is diagnostic of calcinosis cutis.

Chakrabarti et al noted that unnecessary surgery

was avoided in less extensive and uncomplicated

idiopathic scrotal calcinosis by investigating 22

FNAC smears. Our study also had similar findings

as all the above studies, and it correlated well with

the histopathology.

CONCLUSION:

Thus, in our study the rare entity of idiopathic

infantile solitary scrotal calcinosis cutis was

diagnosed by FNAC and confirmed with

histopathology. The patient is in regular follow up

and without any recurrence till date.

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Received on 15/05/2017 Revised on 22/05/2017 Accepted on 25/05/2017

Sprocess characterized by the appearance of · Case Report Senthil Ponnusamy1, Suhailur Rehman2, Sayeedul Hasan Arif3, R S Chana4 ABSTRACT Background: Calcinosis cutis is a process

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