An Unusual Case of Huge Tophaceous Pseudogout Mimicking as a Tumor-Like Lesion around the Ankle Joint: A Case Report and Literature Review

Pseudogout or calcium pyrophosphate dihydrate deposition disease (CPPD) primarily affects the joints and the periarticular tissues. Tophaceous or tumoral pseudogout is a rare form of this disease which is seen around the joints of extremities. It can be misdiagnosed as a neoplastic condition because of its clinicoradiological similarities, and thus, a proper histopathological examination is indispensable. We report one such case of extra-articular deposition of the CPPD crystals in a 65-year-old man who presented with an asymptomatic swelling around the left ankle. Radiographs showed a dense homogenous calcification, and FNAC revealed dense calcium deposits with numerous rhomboid-shaped crystals. It was managed by en bloc excision, and postoperative biopsy reports confirmed the diagnosis. Possibility of pseudogout should be kept as a differential diagnosis in patients presenting with calcified soft tissue swellings and should be subjected to a detailed histopathological examination for confirmation.

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Osteoid Osteoma of the Lateral Cuneiform Bone

Foot & Ankle International ◽

10.1177/107110079401501010 ◽

1994 ◽

Vol 15 (10) ◽

pp. 570-572 ◽

Cited By ~ 4

Author(s):

Fabio Catani ◽

Luca Sangiorgi ◽

Piero Picci ◽

Sandro Giannini

Keyword(s):

Physical Examination ◽

Osteoid Osteoma ◽

Unusual Case ◽

En Bloc ◽

Cuneiform Bone ◽

En Bloc Excision ◽

Bloc Excision ◽

Careful History

An unusual case of osteoid osteoma is reported emphasizing the necessity of a careful history and physical examination combined with an adequate imaging supply. Treatment was surgical with an en bloc excision of the lesion.

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Perforated High-Grade Mixed Neuroendocrine Nonneuroendocrine Neoplasm of Cecum: Unusual Presentation of Rare Disease

Gastrointestinal Tumors ◽

10.1159/000512237 ◽

2021 ◽

pp. 1-6

Author(s):

Gunasekaran Gopalakrishnan ◽

Bheemanathi Hanuman Srinivas ◽

Biju Pottakkat ◽

Senthil Gnanasekaran ◽

Raja Kalayarasan

Keyword(s):

Rare Case ◽

Histopathological Examination ◽

Psoas Muscle ◽

Right Hemicolectomy ◽

Resected Specimen ◽

Radiological Findings ◽

En Bloc ◽

En Bloc Excision ◽

Bloc Excision ◽

The Right

Mixed neuroendocrine nonneuroendocrine neoplasms (MiNENs) are rare neoplasms of the gastrointestinal tract, where the neuroendocrine as well as the nonneuroendocrine components each comprise at least 30% of the tumor. Of all cases of colorectal malignancies, MiNENs constitute around 3–9.6%, with only a few cases reported to be arising in the cecum. Since majority present with nonspecific clinical and radiological findings, its diagnosis preoperatively is almost impossible and these are usually diagnosed after histopathological examination of the resected specimen. Owing to the rarity of these tumors as well as lack of complete molecular characterization, optimal treatment remains unestablished. We, here, report a rare case of MiNENs of the cecum infiltrating the right psoas muscle and presenting with perforation for which right hemicolectomy and en bloc excision of the involved psoas muscle was done followed by adjuvant chemotherapy.

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Deep venous thrombosis manifestation of common femoral vein leiomyoma

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.0062 ◽

2020 ◽

Vol 102 (6) ◽

pp. e141-e144

Author(s):

A Reddy ◽

A Savlania ◽

A Naik ◽

P Rastogi ◽

U Gorsi

Keyword(s):

Deep Vein Thrombosis ◽

Unusual Case ◽

Femoral Vein ◽

En Bloc ◽

Common Femoral Vein ◽

Vein Thrombosis ◽

En Bloc Excision ◽

Bloc Excision ◽

Deep Vein ◽

Spiral Vein Graft

Deep vein thrombosis is a common clinical condition, with well-known risk factors. An unusual case of venous leiomyoma manifesting as a deep vein thrombosis in the left femoral vein of a 55-year-old man was managed successfully at our institution with anticoagulation, en-bloc excision and reconstruction of the femoral vein with spiral vein graft.

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A CASE REPORT OF GIANT GENITAL WARTS

Journal of the Siena Academy of Sciences ◽

10.4081/jsas.2014.4844 ◽

2014 ◽

Vol 6 (1) ◽

Author(s):

L. Grimaldi ◽

R. Cuomo ◽

R. Bilenchi ◽

F. Roviello ◽

G. Nisi ◽

...

Keyword(s):

Transmitted Disease ◽

Genital Warts ◽

Rare Form ◽

En Bloc ◽

Immediate Reconstruction ◽

Sexually Transmitted ◽

En Bloc Excision ◽

Bloc Excision ◽

Sporadic Tumour

Giant genital warts (GGW) represent a rare form of sexually transmitted disease caused by the human papillomavirus, arising more frequently in the vulvar and perianal regions as large exophytic cauliflower-like mass. Estimated rate of recurrence is 60 to 66%, while malignant transformation is possible and it has been reported in 30 to 56% of cases. A 45- years-old woman was admitted to our Structure of Plastic and Reconstructive Surgery, Siena, Italy with an extensive cauliflower- like masses diffused on vulvar and perianal region. The patient was treated in general anaesthesia, with a wide en bloc excision up to free clinical edges and immediate reconstruction of the vulvar continuity. Buschke Lowenstein tumour or giant genital warts is a sporadic tumour with an elevate local recurrence rate. In some cases, surgery can be very difficult and it must be associated to other strategies. An accurate follow-up is always necessary

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Calcium pyrophosphate dihydrate crystal deposition disease

Archives of Internal Medicine ◽

10.1001/archinte.123.6.636 ◽

1969 ◽

Vol 123 (6) ◽

pp. 636-644 ◽

Cited By ~ 7

Author(s):

M. Skinner

Keyword(s):

Calcium Pyrophosphate ◽

Calcium Pyrophosphate Dihydrate ◽

Crystal Deposition ◽

Crystal Deposition Disease ◽

Deposition Disease ◽

Pyrophosphate Dihydrate

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Tumoral calcium pyrophosphate dihydrate deposition disease with bone destruction in the shoulder

Acta Radiologica ◽

10.3109/02841859809172192 ◽

1998 ◽

Vol 39 (3) ◽

pp. 269-272

Author(s):

H. Mizutani ◽

S. Ohba ◽

M. Mizutani ◽

S. Sasaki ◽

K. Ando ◽

...

Keyword(s):

Bone Destruction ◽

Calcium Pyrophosphate ◽

Calcium Pyrophosphate Dihydrate ◽

Deposition Disease ◽

Pyrophosphate Dihydrate

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Newly developed pseudogout arthritis after therapy with MAGE-A4 directed TCR T cells responded to treatment with tocilizumab

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2021-002716 ◽

2021 ◽

Vol 9 (7) ◽

pp. e002716

Author(s):

Sang T. Kim ◽

Jean Tayar ◽

Siqing Fu ◽

Danxia Ke ◽

Elliot Norry ◽

...

Keyword(s):

T Cells ◽

Synovial Fluid ◽

Th17 Cells ◽

Effector Cell ◽

Calcium Pyrophosphate ◽

Calcium Pyrophosphate Dihydrate ◽

Immune Effector Cell ◽

Cell Therapies ◽

Immune Effector ◽

Pyrophosphate Dihydrate

With durable cancer responses, genetically modified cell therapies are being implemented in various cancers. However, these immune effector cell therapies can cause toxicities, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Pseudogout arthritis is an inflammatory arthritis induced by deposition of calcium pyrophosphate dihydrate crystals. Here, we report a case of pseudogout arthritis in a patient treated with MAGE-A4 directed T cell receptor T cells, for fallopian tube cancer. The patient developed CRS and ICANS 7 days after infusion of the T cells. Concurrently, the patient newly developed sudden onset of left knee arthritis. Synovial fluid analyses revealed the presence of calcium pyrophosphate dihydrate crystal. Notably, the pseudogout arthritis was resolved with tocilizumab, which was administered for the treatment of CRS and ICANS. Immunoprofiling of the synovial fluid showed that the proportion of inflammatory interleukin 17 (IL-17)-producing CD4+ T (Th17) cells and amount of IL-6 were notably increased, suggesting a potential role of Th17 cells in pseudogout arthritis after T-cell therapy. To the best of our knowledge, this is the first reported case of pseudogout arthritis after cell therapy. Clinicians, especially hematologists, oncologists and rheumatologists, should be aware that pseudogout arthritis can be associated with CRS/ICANS.

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Calcium Pyrophosphate Dihydrate Crystals Increase the Granulocyte/Monocyte Progenitor (GMP) and Enhance Granulocyte and Monocyte Differentiation In Vivo

International Journal of Molecular Sciences ◽

10.3390/ijms22010262 ◽

2020 ◽

Vol 22 (1) ◽

pp. 262

Author(s):

Nobuyuki Onai ◽

Chie Ogasawara

Keyword(s):

Cell Differentiation ◽

Peripheral Blood ◽

Calcium Pyrophosphate ◽

Hematopoietic Progenitor Cell ◽

Calcium Pyrophosphate Dihydrate ◽

Dependent Manner ◽

Concentration Dependent Manner ◽

Hematopoietic Stem ◽

Cppd Crystal ◽

Pyrophosphate Dihydrate

Calcium pyrophosphate dihydrate (CPPD) crystals are formed locally within the joints, leading to pseudogout. Although the mobilization of local granulocytes can be observed in joints where pseudogout has manifested, the mechanism of this activity remains poorly understood. In this study, CPPD crystals were administered to mice, and the dynamics of splenic and peripheral blood myeloid cells were analyzed. As a result, levels of both granulocytes and monocytes were found to increase following CPPD crystal administration in a concentration-dependent manner, with a concomitant decrease in lymphocytes in the peripheral blood. In contrast, the levels of other cells, such as dendritic cell subsets, T-cells, and B-cells, remained unchanged in the spleen, following CPPD crystal administration. Furthermore, an increase in granulocytes/monocyte progenitors (GMPs) and a decrease in megakaryocyte/erythrocyte progenitors (MEPs) were also observed in the bone marrow. In addition, CPPD administration induced production of IL-1β, which acts on hematopoietic stem cells and hematopoietic progenitors and promotes myeloid cell differentiation and expansion. These results suggest that CPPD crystals act as a “danger signal” to induce IL-1β production, resulting in changes in course of hematopoietic progenitor cell differentiation and in increased granulocyte/monocyte levels, and contributing to the development of gout.

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