Idiopathic scrotal calcinosis

Idiopathic scrotal calcinosis
Other names	Idiopathic calcified nodules of the scrotum[1]
Specialty	Dermatology

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]

Without known links to other lesions or systemic pre-conditions, scrotal calcinosis was considered idiopathic. It is not related to calcium phosphate imbalance or renal insufficiency.^[5] By 2010, studies supported that epidermoid cysts are believed to be caused by dystrophic calcification. This process involves subclinical inflammation, rupture, calcification, and cyst wall obliteration.^[6] 

Presentation

The presentation is as follows:^{[citation needed]}

• 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][7] Originally considered idiopathic condition. Now accepted that majority of cases develop from dystrophic calcification of cyst contents.^{[citation needed]}

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,^[8] 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

The prognosis is as follows:^{[citation needed]}

• Benign condition
• Slow progression throughout life
• Lesions remain discrete and do not become confluent

Epidemiology

• Incidence: uncommon^{[citation needed]}
• Age: children and young adults^{[citation needed]}

History

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

See also

• Calcinosis cutis
• Skin lesion
• List of cutaneous conditions

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. Shapiro, L.; Platt, N.; Torres-Rodríguez, V. M. "Idiopathic calcinosis of the scrotum". Archives of Dermatology. 102 (2): 199–204. ISSN 0003-987X. PMID 5464321.
6. Dubey, Suparna; Sharma, Rajeev; Maheshwari, Veena (2010-02-15). "Scrotal calcinosis: idiopathic or dystrophic?". Dermatology Online Journal. 16 (2): 5. ISSN 1087-2108. PMID 20178701.
7. Dubey S, Sharma R, Maheshwari V (2010). "Scrotal calcinosis: idiopathic or dystrophic?". Dermatol. Online J. 16 (2): 5. doi:10.5070/D34QV0S2PG. PMID 20178701.
8. 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.