Parathyroidectomy May Cause Remission of Uraemic Tumoral Calcinosis in Haemodialysis Patients

Few cases of uraemic tumoral calcinosis (UTC) have been reported. This study aimed to investigate the clinical efficacy of parathyroidectomy for UTC. Historical clinical data of patients with end-stage renal disease and UTC who underwent parathyroidectomy were analysed. Absorption of metastatic calcification was compared before and after operation. Changes in intact parathyroid hormone, serum calcium, phosphorus, and alkaline phosphatase levels were analysed before parathyroidectomy and at 1 week and 3, 6, and 12 months after parathyroidectomy. Eight patients met the enrolment criteria (men, 6; mean age, 38.6 SD 10.9 years). Uraemic tumoral calcinosis, which developed 2–8 years after dialysis began, was caused by secondary hyperparathyroidism. Massive calcium deposition was found in the shoulder (n = 6), hip (n = 3), and elbow (n = 2). Four patients had > 2 joints affected, and a single joint was involved for four patients. Seven patients had rapid remission (< 6 months) of the masses after parathyroidectomy. In one patient, the mass remained unabsorbed until 6 months postoperatively. Hypocalcaemia occurred in all patients where parathyroidectomy was successful, and calcium supplementation was required 1 year postoperatively. Serum intact parathyroid hormone levels on day 7 and at 3 and 6 months postoperatively decreased significantly from baseline and remained low 1 year postoperatively (22.015 SD33.134 pg/mL). Postoperative phosphorus levels were significantly lower than preoperative levels (p < 0.05), but no significant difference was found in alkaline phosphatase levels (p > 0.05). Parathyroidectomy has promising efficacy for UTC treatment and regulation of serum intact parathyroid hormone and phosphorus. Hypocalcaemia is a common complication after parathyroidectomy. Current Controlled Trials ChiCTR2000041311, date of registration: Dec. 23, 2020.

A Case Report of Autopsy: Large Mass of Pulmonary Metastatic Calcification in a Patient with End-Stage Renal Disease

Introduction/Objective Metastatic calcifications are reported in patients with end-stage renal disease (ESRD) in radiology literature but there are no pathologic reports regarding this clinical scenario in autopsy. Methods/Case Report We report the case of a 27-year-old African American man with nephrotoxic injury secondary to gentamicin treatment at a young age leading to ESRD requiring dialysis who then later developed congestive heart disease and arrhythmia. Prior to the patient’s last hospitalization, he had normal breath sounds with no signs of respiratory distress, rales, or wheezing. Imaging of the chest showed a patchy density in the right lung and a large parenchymal calcification. During autopsy, the patient was found to have bilateral markedly small and atrophic kidneys (left kidney weight: 27.5 g, size: 5.7 x 4.4 x 3.0 cm and right kidney weight: 30.6 g, size: 5.9 x 4.4 x 3.1 cm). Microscopically, the kidneys showed diffuse global glomerulosclerosis, atrophy of cortex, severe interstitial fibrosis, and tubular atrophy with thickened arteries as well as many foci of calcifications. A large mass measuring 3.5 x 2.4 x 1.9 cm was identified in the right middle lobe of the lung. Sections of the mass revealed large calcifications which were confirmed microscopically. In addition, concentric heart hypertrophy was identified with heart weight of 925 g and left ventricle measuring up to 2.2 cm. Calcifications (ranging from 0.2 – 0.5 mm) were also identified on the left atrial wall as well as a 1.2 x 0.8 x 0.6 cm mitral valve nodule along with additional microcalcifications within the myocardium. Results (if a Case Study enter NA) NA Conclusion In conclusion, our autopsy case supports previous radiologic reports that metastatic calcification can be dramatically present in the lung in patients with ESRD.

Metastatic Pulmonary Calcification Detected on 18F-FDG PET/CT and 99mTc-MDP Bone Scan

Metastatic calcification relates to abnormal calcification resulting from hypercalcemia and can affect soft tissues, skeletal muscle, myocardium, lungs, stomach, kidneys, and blood vessels. We describe a case of metastatic pulmonary calcification in a 71-year-old male, images with 18F-fluorodeoxyglucose (FDG) PET/CT and 99mTc- methylene diphosphonate (MDP) bone scan.

Determination of the parathyroid hormone reference interval in patients with different stages of the chronic kidney disease

Secondary hyperparathyroidism (SHPT) is one of the most clinically significant complications of chronic kidney disease (CKD) due to associated mineral, bone disorders, and metastatic calcification. The indicators of mineral and bone metabolism of 635 patients with different CKD stages and 50 persons of the control group were analyzed using a neural network algorithm and the mathematical technology BootStrаp, which allowed determining the target PTH intervals for each stage in patients with CKD, corresponding to the optimal indicators of mineral density and metabolism bone tissue, in order to improve the survival of this category of patients. It was found that the upper limit of the reference interval of the PTH level in patients with CKD and GFR > 35 ml/min coincides with the general population, in patients with CKD and GFR 15‒35 ml/min it is 185 pg/ml, which is 3 times higher than in the general population, and in patients with CKD and GFR < 15 ml/min it is 500 pg/ml (7.5 times higher than in the general population). In dialysis patients with the PTH level of 500‒1500 pg/ml, it is possible to maintain satisfactory parameters of bone metabolism, and the PTH level of >1500 pg/ml determines the extreme risk of developing severe SHPT complications.

Metastatic calcification and granulomatous grastroenteritis associated to Pythium insidiosum in a dog

Pythiosis is a granulomatous process of which the oomycete Pythium insidiosum is its etiological agent. It can affect animals and humans alike and its infection occurs when free zoospores in the water get in contact with the target tissues and encyst. The disease often occurs in tropical places with abundance of water and aquatic plants that host the fungus. Dogs infection is predominantly gastric with granuloma formations in the stomach and intestine with progressive signs of vomiting, weight loss and diarrhea. In this case report, we described clinical, surgical, necroscopic and histopathological findings of a one year and two months old, male boxer that presented clinical signs of anorexia and persistent vomiting. It was noticed on ultrasound examination an increase in stomach and intestine thickness. Laparotomy confirmed a mass affecting the gastric wall which, an incision biopsy, showed an abundant fibrous tissue associated with granulomatous reaction that was surrounded by tubuliform structures. Due to clinical complications, euthanasia was performed and in necroscopic examination a markedly increased stomach and duodenum was observed. An; histological examination of this areas it was observed that they contained granulation tissue with giant cells and epithelioids macrophages around necrosed areas associated with lymphocytes infiltrate. Also, it was possible to observe tubuliform structures by the Grocott-Gomori’s Methenamine Silver (GMS) stain, this finding is compatible with the agent Pythium insidiosum. Therefore, this presumptive identification was confirmed by PCR analysis which amplicon had 97.83% similarity with current available genomic sequence of P. insidiosum.

A case report of malignant primary pericardial mesothelioma with atypical imaging appearance: multimodality imaging with histopathological correlation

Background Primary pericardial mesothelioma is a rare primary cardiac malignancy, with three main histopathological types, sarcomatoid histotype being the rarest. The imaging features were atypical due to concomitant extensive calcification, which resulted in aggravated differential diagnosis. Case summary A 45-year-old man presented to our hospital with non-specific clinical symptoms. According to clinical history, a mediastinal tumour had been suspected with a previous unsuccessful attempt of transthoracic computed tomography-guided biopsy at an overseas hospital with limited data of performed imaging procedures. Multimodality imaging at our centre revealed extensively calcified solid masses in the pericardium, invading the left atrium. As the imaging features suggested an atypical primary pericardial malignancy, a diagnostic thoracoscopy was performed. Histopathological analysis of specimen revealed sarcomatoid type of pericardial mesothelioma with areas of necrosis and foci of osteogenic differentiation. Despite planned treatment, 2 weeks after histological diagnosis, the patient passed away due to perforated peptic ulcer-related sepsis. Discussion The presence of extensive calcification in the lesion resulted in a challenging imaging workup and diagnosis. Initial differential diagnosis included primary or metastatic calcification-prone tumour, secondary calcification due to haemorrhage after previous interventional procedure and other pathologies, such as tuberculous pericarditis, calcified amorphous tumour, among others. Calcification may be part of the histological tumour characteristics; however, proper history taking is crucial as concomitant diseases, previous treatment, and interventional procedures may alter the imaging pattern.