Cervical tumoral calcinosis in a patient on maintenance hemodialysis

Abstract

Tumoral calcinosis is a rare disorder that most often occurs in periarticular regions of the extremities. Here, we report a case of cervical tumoral calcinosis in a hemodialysis patient. The patient was a 67-year-old Japanese man on maintenance dialysis for 5 years. He presented with a 2-week history of progressive cervical myelopathy in March 2006. Findings on cervical plain radiography showed spondylotic change and narrowing of the disc space between C-5 and C-6, but there was no definitive calcification. A spinal mass lesion posterior to the spinal cord at C3-4 level, resulting in marked spinal cord compression was demonstrated on magnetic resonance imaging of the cervical spine. Thus, the tentative preoperative diagnosis was cervical spine tumor. The patient underwent surgery to remove the mass for spinal cord decompression and stabilization of the cervical spine via a C3-C4 laminectomy and laminoplasty. Histologically, the lesion consisted of numerous nodules with calcified materials and a foreign body granulation reaction of multinucleated giant cells ; the histological characteristics were identical to those of tumoral calcinosis. Eventually, we diagnosed cervical tumoral calcinosis. Tumoral calcinosis should be considered in a maintenance hemodialysis patient with a mass lesion involving the cervical spine even if patients do not have metabolic abnormalities involving calcium/phosphate or metastatic calcification.