Idiopathic scrotal calcinosis is a cutaneous condition characterized by calcification of the skin resulting from the deposition of calcium and phosphorus occurring on the scrotum.[2]: 528 However, the levels of calcium and phosphate in the blood are normal.[3] Idiopathic scrotal calcinosis typically affects young males, with an onset between adolescence and early adulthood.[3] The scrotal calcinosis appears, without any symptoms, as yellowish nodules that range in size from 1 mm to several centimeters.[4]
| Idiopathic scrotal calcinosis | |
|---|---|
| Other names | Idiopathic calcified nodules of the scrotum[1] |
| Specialty | Dermatology |
Without known links to other lesions or systemic pre-conditions, scrotal calcinosis was considered idiopathic. It is not related to calcium phosphate imbalance or renal insufficiency.[5] By 2010, studies supported that epidermoid cysts are believed to be caused by dystrophic calcification. This process involves subclinical inflammation, rupture, calcification, and cyst wall obliteration.[6]
Presentation
edit- Single or multiple hard, marble-like nodules of varying size affecting scrotal skin.
- Nodules vary in size from a few millimeters to a few centimeters.
- Usually start to appear in childhood or early adult life
- Over time, nodules increase in number and size
- Nodules may break down and discharge chalky material
- Rarely, lesions may be polypoid
- Usually asymptomatic
Etiology
editThe cause is not well defined.[4][7] Originally considered idiopathic condition. Now accepted that majority of cases develop from dystrophic calcification of cyst contents.
Diagnostic
edit- Clinically Relevant Pathologic Features
- Lesions slowly progress throughout life
- They slowly increase in number and size
- Nodules are mobile and do not attach to underlying structures
Pathologic Interpretation Pearls
- Globular and granular purple deposits within dermis surrounded by giant cell granulomatous reaction
- Sometimes remnants of cystic lesion can be identified
- Very distinctive appearance with almost no histologic differential diagnosis.
Treatment
editTreatment may involve surgery,[8] which is currently the only recommended intervention.[4] Surgery should include the removal of even small nodules, to prevent the recurrence of the scrotal calcinosis.[4]
Prognosis
edit- Benign condition
- Slow progression throughout life
- Lesions remain discrete and do not become confluent
Epidemiology
edit- Incidence: uncommon
- Age: children and young adults
History
editScrotal calcinosis was first described in 1883 by Lewinski.[4]
See also
editReferences
edit- ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
- ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6.
- ^ a b Grenader, Tal; Shavit, Linda (Aug 18, 2011). "Scrotal Calcinosis". New England Journal of Medicine. 365 (7): 647. doi:10.1056/NEJMicm1013803. PMID 21848465.
- ^ a b c d e Khallouk A, Yazami OE, Mellas S, Tazi MF, El Fassi J, Farih MH (2011). "Idiopathic scrotal calcinosis: a non-elucidated pathogenesis and its surgical treatment". Reviews in Urology. 13 (2): 95–7. PMC 3176555. PMID 21935341.
- ^ Shapiro, L.; Platt, N.; Torres-Rodríguez, V. M. "Idiopathic calcinosis of the scrotum". Archives of Dermatology. 102 (2): 199–204. ISSN 0003-987X. PMID 5464321.
- ^ Dubey, Suparna; Sharma, Rajeev; Maheshwari, Veena (2010-02-15). "Scrotal calcinosis: idiopathic or dystrophic?". Dermatology Online Journal. 16 (2): 5. ISSN 1087-2108. PMID 20178701.
- ^ Dubey S, Sharma R, Maheshwari V (2010). "Scrotal calcinosis: idiopathic or dystrophic?". Dermatol. Online J. 16 (2): 5. doi:10.5070/D34QV0S2PG. PMID 20178701.
- ^ Karaca M, Taylan G, Akan M, Eker G, Gideroglu K, Gul AE (April 2010). "Idiopathic Scrotal Calcinosis: Surgical Treatment and Histopathologic Evaluation of Etiology". Urology. 76 (6): 1493–1495. doi:10.1016/j.urology.2010.02.001. PMID 20381842.