Indian Journal of Urology
CASE REPORT
Year
: 2001  |  Volume : 17  |  Issue : 2  |  Page : 184--185

Idiopathic scrotal calcinosis - a case report with review of literature


PS Seethalakshmi, Sangeeta B Desai, SA Pradhan, Roshni F Chinoy 
 Departments of Pathology and Surgery; Tata Memorial Hospital, Parel, Mumbai, India

Correspondence Address:
Roshni F Chinoy
Department of Pathology, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai - 400 012
India




How to cite this article:
Seethalakshmi P S, Desai SB, Pradhan S A, Chinoy RF. Idiopathic scrotal calcinosis - a case report with review of literature.Indian J Urol 2001;17:184-185


How to cite this URL:
Seethalakshmi P S, Desai SB, Pradhan S A, Chinoy RF. Idiopathic scrotal calcinosis - a case report with review of literature. Indian J Urol [serial online] 2001 [cited 2022 Aug 10 ];17:184-185
Available from: https://www.indianjurol.com/text.asp?2001/17/2/184/21064


Full Text

 Case Report



A 28-year-old man presented with multiple painless scrotal nodules. There was no history of any other symp­toms including those of any endocrinologic, neoplastic or autoimmune diseases. His biochemical evaluation was also within normal limits. The patient opted for excision of the lesion for cosmetic reasons.

A specimen of partial scrotectomy was received. The excised scrotal skin measured 7 x 6 cm in size. Multiple nodular elevations were present on the skin surface with areas of hypopigmentation. On cut section, the nodules were firm, white with multiple chalky and gritty areas. There were no areas of ulceration or discharge on the skin surface.

On microscopy there were multiple deposits of basophilic calcified material in the dermis [Figure 1]. A foreign body giant cell reaction was seen around few deposits. No evidence of any epidermoid cysts or any of its remnant squamous epithe­lium was noted around the deposits. Immunohistochemical evaluation was done using cytokeratin antibody with negative results, which confirmed the absence of epithelium. A diagno­sis of idiopathic scrotal calcinosis was made. Subsequent to the surgery, the patient was asymptomatic and has done well on follow-up.

 Comments



Idiopathic scrotal calcinosis (ICS) is an uncommon entity first reported by Lewenski in 1883. To the best of our knowledge 78 cases have been reported to date. [1],[2] Most of the cases reported including ours present between 20 and 40 years of age. [3]

According to literature, although several circumscript cal­cifications of extrascrotal skin have been reported, the strictly scrotal location and dermal calcification is the unique fea­ture of ICS. [2] Patients may be asymptomatic or present with swelling, heaviness, itching, ulceration and discharge of the calcific material. [3] Unusually the condition may present as a polypoidal mass. [4] In our case the patient was asymptomatic, but for the swelling.

There is no consensus about the pathogenesis of this condition. Most of the patients described including ours do not have any underlying cause to consider metastatic calcification as an etiology. Among other reports avail­able, it has been proposed that ICS is secondary to dys­trophic calcification of the dartos muscle or the dermis following minor trauma or an impacted foreign body. [2] ­There was no demonstrable foreign body or no known history of trauma in our patient. Eccrine ducts and epider­mal cysts have also been proposed as being the foci of calcification; the latter possibility has been explored by many others. [1],[2],[4],[5] The granulomatous reaction seen sur­rounding a few of the deposits is speculated to be due to rupture of the cysts with loss of their wall. [5] Consequently no remnants of keratinous cysts or their lining have been demonstrated in many of these cases including ours.

To conclude, ICS could be attributed to dystrophic calci­fication. These cases are managed effectively by local ex­cision. This case has been presented for its relative rarity.

References

1Akosa AB. Gilliland EA, Ali MH. Khoo CT. Idiopathic scrotal cal­cinosis: a possible etiology reaffirmed. Br J Plast Surg 1989: 42: 324-327.
2Michl UHG, Gross AJ, Loy V, Dieckmann KP. Idiopathic calcino­sis of the scrotum - A specific entity of the scrotal skin. Scand J Urol Nephrol 1994; 28: 213-217.
3Shapiro L. Platt. N, Tones-Rodriguez VM. Idiopathic Calcinosis of the Scrotum. Arch Dermatol Res 1970: 102: 199-204.
4Polk P, McCuthen WT, Phillips JG. Biggs PJ. Polypoidal Scrotal calcinosis: an uncommon variant of scrotal calcinosis. South Med J 1996: 89: 896-897.
5Dim M. Colafranceschi M. Should scrotal calcinosis still be termed idiopathic? Am J Dermatopathol 1998: 20: 399-402.