Skip to main content

Advertisement

SpringerLink
Log in

Uremic tumoral calcinosis causing atlantoaxial subluxation and spinal cord compression in a patient on continuous ambulatory peritoneal dialysis

  • Nephrology - Case Report
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Uremic tumoral calcinosis (UTC) is a form of metastatic tissue calcification unique to dialysis patients, manifesting with amorphous and cystic masses containing calcium phosphate deposits in periarticular soft tissue. An involvement of the cervical spine with bone destruction is extremely rare in UTC. We describe a 44-year-old uremic female on long-term continuous ambulatory peritoneal dialysis who developed UTC in the peri-odontoid region with consequent atlantoaxial subluxation and spinal cord compression, featuring severe neck soreness, headache, and hypertension. Surgical removal of the destructive cervical spine lesion, showing typical tumoral calcinosis on histology, completely resolved the clinical symptoms. To date, the patient maintains uneventful postoperative course with tight control of serum phosphorus, calcium, and secondary hyperparathyroidism by medical treatment. We also review other reported unusual cases of UTC involving the cervical spine and discuss the differential diagnosis of destructive spinal lesions in uremic patients, such as UTC, dialysis-related amyloidosis, and brown tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Cofan F, Garcia S, Combalia A et al (1999) Uremic tumoral calcinosis in patients receiving longterm hemodialysis therapy. J Rheumatol 26:379–385

    PubMed  CAS  Google Scholar 

  2. Hamada J, Tamai K, Saotome K et al (2006) Uremic tumoral calcinosis in hemodialysis patients: clinicopathological findings and identification of calcific deposits. J Rheumatol 33:119–126

    PubMed  CAS  Google Scholar 

  3. Chu HY, Chu P, Lin SH et al (2011) Uremic tumoral calcinosis in patients on peritoneal dialysis: clinical, radiographic, and laboratory features. Perit Dial Int 31:430–439

    Article  PubMed  Google Scholar 

  4. Möckel G, Buttgereit F, Perka C et al (2005) Tumoral calcinosis revisited: pathophysiology and treatment. Rheumatol Int 25:55–59

    Article  PubMed  Google Scholar 

  5. Braun J (2005) Extraosseous calcification in patients with chronic renal failure—no escape? Nephrol Dial Transplant 20:2054–2059

    Article  PubMed  Google Scholar 

  6. Fernández E, Amoedo ML, Montoliu J et al (1993) Tumoral calcinosis in haemodialysis patients without severe hyperparathyroidism. Nephrol Dial Transplant 8:1270–1273

    PubMed  Google Scholar 

  7. Matsukado K, Amano T, Nagata S et al (2001) Tumoral calcinosis in the upper cervical spine causing progressive radiculomyelopathy—case report. Neurol Med Chir 41:411–414

    Article  CAS  Google Scholar 

  8. Carlson AP, Yonas HM, Turner PT (2007) Disorder of tumoral calcinosis of the spine: illustrative case study and review of literature. J Spinal Disord Tech 20:97–103

    Article  PubMed  Google Scholar 

  9. Jackson W, Sethi A, Vaidya R et al (2007) Unusual spinal manifestation in secondary hyperparathyroidism: a case report. Spine 32:557–560

    Article  Google Scholar 

  10. Remy-Leroux V, Reguiaï Z, Bernard P et al (2009) Tumoral calcinosis at an unusual site in a haemodialysis patient. Ann Dermatol Venereol 136:350–354

    Article  PubMed  CAS  Google Scholar 

  11. Bland JH, Boushey DR (1990) Anatomy and physiology of the cervical spine. Semin Arthritis Rheum 20:1–20

    Article  PubMed  CAS  Google Scholar 

  12. Susan RM, Nikolai B (2001) Joints of the cervical vertebral column. J Orthop Sports Phys Ther 31:174–182

    Article  Google Scholar 

  13. Bogduk N, Govind J (2009) Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol 8:959–968

    Article  PubMed  Google Scholar 

  14. Olsen KM, Chew FS (2006) Tumoral calcinosis: pearls, polemics, and alternative possibilities. Radiographics 26:871–885

    Article  PubMed  Google Scholar 

  15. Danesh F, Ho LT (2001) Dialysis-related amyloidosis: history and clinical manifestations. Semin Dial 14:80–85

    Article  PubMed  CAS  Google Scholar 

  16. Theodorou DJ, Theodorou SJ, Resnick D (2002) Imaging in dialysis spondyloarthropathy. Semin Dial 15:290–296

    Article  PubMed  Google Scholar 

  17. Mateo L, Massuet A, Sánchez Torres MC et al (2011) Brown tumor of the cervical spine: a case report and review of the literature. Clin Rheumatol 30:419–424

    Article  PubMed  Google Scholar 

  18. Kaya RA, Cavuşoğlu H, Tanik C et al (2007) Spinal cord compression caused by a brown tumor at the cervicothoracic junction. Spine J 7:728–732

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, No. 325, Section 2, Cheng-Kung Road, Neihu, 114, Taipei, Taiwan

    Chin-Chun Chang, Chih-Chien Sung & Shih-Hua Lin

  2. Department of Neurosurgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Chung-Ching Hsia

Authors
  1. Chin-Chun Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chih-Chien Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chung-Ching Hsia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shih-Hua Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shih-Hua Lin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chang, CC., Sung, CC., Hsia, CC. et al. Uremic tumoral calcinosis causing atlantoaxial subluxation and spinal cord compression in a patient on continuous ambulatory peritoneal dialysis. Int Urol Nephrol 45, 1511–1516 (2013). https://doi.org/10.1007/s11255-012-0215-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-012-0215-z

Keywords

Search

Navigation