Idiopathic scrotal calcinosis

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 namesIdiopathic calcified nodules of the scrotum[1]
SpecialtyDermatology

Presentation
  • 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

The cause is not well defined.[4][5] Originally considered idiopathic condition. Now accepted that majority of cases develop from dystrophic calcification of cyst contents.

Diagnostic
  • 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

Treatment may involve surgery,[6] 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
  • Benign condition
  • Slow progression throughout life
  • Lesions remain discrete and do not become confluent

Epidemiology
  • Incidence: uncommon
  • Age: children and young adults

History

Scrotal calcinosis was first described in 1883 by Lewinski.[4]

See also

References
  1. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  2. James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6.
  3. Grenader, Tal; Shavit, Linda (Aug 18, 2011). "Scrotal Calcinosis". New England Journal of Medicine. 365 (7): 647. doi:10.1056/NEJMicm1013803. PMID 21848465.
  4. 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.
  5. Dubey S, Sharma R, Maheshwari V (2010). "Scrotal calcinosis: idiopathic or dystrophic?". Dermatol. Online J. 16 (2): 5. PMID 20178701.
  6. 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.


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