Tumoral Calcinosis: Pearls, Polemics, and Alternative Possibilities

Published Online:https://doi.org/10.1148/rg.263055099

Massive periarticular calcinosis of the soft tissues is a unique but not rare radiographic finding. On the contrary, tumoral calcinosis is a rare familial disease. Unfortunately, the term tumoral calcinosis has been liberally and imprecisely used to describe any massive collection of periarticular calcification, although this term actually refers to a hereditary condition associated with massive periarticular calcification. The inconsistent use of this term has created confusion throughout the literature. More important, if the radiologist is unfamiliar with tumoral calcinosis or disease processes that mimic this condition, then diagnosis could be impeded, treatment could be delayed, and undue alarm could be raised, possibly leading to unwarranted surgical procedures. The soft-tissue lesions of tumoral calcinosis are typically lobulated, well-demarcated calcifications that are most often distributed along the extensor surfaces of large joints. There are many conditions with similar appearances, including the calcinosis of chronic renal failure, calcinosis universalis, calcinosis circumscripta, calcific tendonitis, synovial osteochondromatosis, synovial sarcoma, osteosarcoma, myositis ossificans, tophaceous gout, and calcific myonecrosis. The radiologist plays a critical role in avoiding unnecessary invasive procedures and in guiding the selection of appropriate tests that can result in a conclusive diagnosis of tumoral calcinosis.

© RSNA, 2006


  • 1 GiardA. Sur la calcification hibernale. C R Soc Biol1898; 10: 1013–1015. Google Scholar
  • 2 DuretMH. Tumours multiples et singulieres des bourses sereuses (endotheliomes, peutetre d’origine parasitaire). Bull Mem Soc Anat Paris1899; 74: 725–733. Google Scholar
  • 3 TeutschlaenderO. Die lipoido-calcinosis oder lipoidkalkgicht. Beitr Pathol Ana1949; 110: 402–432. Google Scholar
  • 4 TeutschlaenderO. Aur kenntnis der lipoido-calcinosis progrediens. Zentralbl Allg Pathol1951; 87: 1–15. MedlineGoogle Scholar
  • 5 BarriereH, Welin J, Lenne Y, Visset J, Vigier P. Teutschlaender lipo-calcino-granulomatosis or tumoral calcinosis of Inclan [in French]. Ann Dermatol Venereol1977; 104: 136–140. MedlineGoogle Scholar
  • 6 InclanA, Leon P, Camejo MG. Tumoral calcinosis. J Am Med Assoc1943; 121: 490–495. CrossrefGoogle Scholar
  • 7 HarkessJW, Peters HJ. Tumoral calcinosis: a report of six cases. J Bone Joint Surg Am1967; 49: 721–731. Crossref, MedlineGoogle Scholar
  • 8 PalmerPE. Tumoral calcinosis. Br J Radiol1966; 39: 518–525. Crossref, MedlineGoogle Scholar
  • 9 LaffertyFW, Reynolds ES, Pearson OH. Tumoral calcinosis: a metabolic disease of obscure etiology. Am J Med1965; 38: 105–118. Crossref, MedlineGoogle Scholar
  • 10 ChewFS, Crenshaw WB. Idiopathic tumoral calcinosis. AJR Am J Roentgenol1992; 158: 330. Crossref, MedlineGoogle Scholar
  • 11 MartinezS, Vogler JB, Harrelson JM, Lyles KW. Imaging of tumoral calcinosis: new observations. Radiology1990; 174: 215–222. LinkGoogle Scholar
  • 12 GalG, Metzker A, Garlick J, Gold Y, Calderon S. Head and neck manifestations of tumoral calcinosis. Oral Surg Oral Med Oral Pathol1994; 77: 158–166. Crossref, MedlineGoogle Scholar
  • 13 HunterIP, MacDonald DG, Ferguson MM, et al. Developmental abnormalities of the dentine and pulp associated with tumoral calcinosis. Br Dent J1973; 135: 446–448. Crossref, MedlineGoogle Scholar
  • 14 DimitroulisG. Tumoral calcinosis of the articular disc of the temporomandibular joint: a rare entity. J Oral Maxillofac Surg2004; 62: 1551–1553. Crossref, MedlineGoogle Scholar
  • 15 McKeePH, Liomba NG, Hutt MS. Tumoral calcinosis: a pathological study of fifty-six cases. Br J Dermatol1982; 107: 669–674. Crossref, MedlineGoogle Scholar
  • 16 OhashiK, Yamada T, Ishikawa T, Yamaguchi S, Nakajima H, Takagi M. Idiopathic tumoral calcinosis involving the cervical spine. Skeletal Radiol1996; 25: 388–390. Crossref, MedlineGoogle Scholar
  • 17 ViegasSF, Evans EB, Calhoun J, Goodwiller SE. Tumoral calcinosis: a case report and review of the literature. J Hand Surg [Am]1985; 10: 744–748. Crossref, MedlineGoogle Scholar
  • 18 GreenbergSB. Tumoral calcinosis in an infant. Pediatr Radiol1990; 20: 206–207. Crossref, MedlineGoogle Scholar
  • 19 McGuinnessFE. Hyperphosphataemic tumoral calcinosis in bedouin Arabs: clinical and radiological features. Clin Radiol1995; 50: 259–264. Crossref, MedlineGoogle Scholar
  • 20 GhanchiF, Ramsay A, Coupland S, Barr D, Lee WR. Ocular tumoral calcinosis: a clinicopathologic study. Arch Ophthalmol1996; 114: 341–345. Crossref, MedlineGoogle Scholar
  • 21 WilsonMP, Lindsley CB, Warady BA, Johnson JA. Hyperphosphatemia associated with cortical hyperostosis and tumoral calcinosis. J Pediatr1989; 114: 1010–1013. Crossref, MedlineGoogle Scholar
  • 22 NarchiH. Hyperostosis with hyperphosphatemia: evidence of familial occurrence and association with tumoral calcinosis. Pediatrics1997; 99: 745–748. Crossref, MedlineGoogle Scholar
  • 23 Ballina-GarciaFJ, Quiero-Silva R, Fernandez-Vega F, et al. Diaphysitis in tumoral calcinosis syndrome. J Rheumatol1996; 23: 2148–2151. MedlineGoogle Scholar
  • 24 ClarkeE, Swischuk LE, Hayden CK Jr. Tumoral calcinosis, diaphysitis, and hyperphosphatemia. Radiology1984; 151: 643–646. LinkGoogle Scholar
  • 25 KaplanG, Vinceneux P, Grossin M, Kahn MF. Association of tumoral calcinosis and pseudoxanthoma elasticum: apropos of a case [in French]. Rev Rhum Mal Osteoartic1980; 47: 657–660. MedlineGoogle Scholar
  • 26 MitnickPD, Goldfarb S, Statopolsky E, et al. Calcium and phosphate metabolism in tumoral calcinosis. Ann Intern Med1980; 92: 482–487. Crossref, MedlineGoogle Scholar
  • 27 PrinceMJ, Schaefer PC, Goldsmith RS, et al. Hyperphosphatemic tumoral calcinosis. Ann Intern Med1982; 96: 586–591. Crossref, MedlineGoogle Scholar
  • 28 ZerwekhJE, Sanders LA, Townsend J, Pak CY. Tumoral calcinosis: evidence for concurrent defects in renal tubular phosphorus transport and in 1 alpha,25-dihydroxycholecalciferol synthesis. Calcif Tissue Int1980; 32: 1–6. Crossref, MedlineGoogle Scholar
  • 29 TopazO, Shurman DL, Bergman R, et al. Mutations in GALNT3, encoding a protein involved in O-linked glycosylation, cause familial tumoral calcinosis. Nat Genet2004; 36: 579–581. Crossref, MedlineGoogle Scholar
  • 30 Benet-PagesA, Orlik P, Strom TM, Lorenz-Depiereux B. An FGF23 missense mutation causes familial tumoral calcinosis with hyperphosphatemia. Hum Mol Genet2005; 14: 385–390. Crossref, MedlineGoogle Scholar
  • 31 LarssonT, Davis SI, Garringer HJ, et al. FGF23 mutants causing familial tumoral calcinosis are differentially processed. Endocrinology2005; 146: 3883–3891. Crossref, MedlineGoogle Scholar
  • 32 SlavinRE, Wen J, Kumar D, Evans EB. Familial tumoral calcinosis: a clinical, histopathologic, and ultrastructural study with an analysis of its calcifying process and pathogenesis. Am J Surg Pathol1993; 17: 788–802. Crossref, MedlineGoogle Scholar
  • 33 SmackD, Norton SA, Fitzpatrick SE. Proposal for pathogenesis-based classification of tumoral calcinosis. Int J Dermatol1996; 35: 265–271. Crossref, MedlineGoogle Scholar
  • 34 HugI, Guncaga J. Tumoral calcinosis with sedimentation sign. Br J Radiol1974; 47: 734–736. Crossref, MedlineGoogle Scholar
  • 35 AdamsWM, Laitt RD, Davies M, O’Donovan DG. Familial tumoral calcinosis: association with cerebral and peripheral aneurysm formation. Neuroradiology1999; 41: 351–355. Crossref, MedlineGoogle Scholar
  • 36 StewartVL, Herling P, Marray KD. Calcification in soft tissues. JAMA1983; 250: 78–81. Crossref, MedlineGoogle Scholar
  • 37 LylesKW, Burkes EJ, Ellis GJ, Lucas KJ, Dolan EA, Drezner MK. Genetic transmission of tumoral calcinosis: autosomal dominant with variable clinical expressivity. J Clin Endocrinol Metab1985; 60: 1093–1096. Crossref, MedlineGoogle Scholar
  • 38 EisenbergB, Tzamaloukas AH, Hartshorne MR, Listrom MB, Arrington ER, Sherrard DJ. Periarticular tumoral calcinosis and hypercalcemia in a hemodialysis patient without hyperparathyroidism: a case report. J Nucl Med1990; 31: 1099–1103. MedlineGoogle Scholar
  • 39 FrancoM, Van Elslande L, Passeron C, et al. Tumoral calcinosis in hemodialysis patients: a review of three cases. Rev Rhum Engl Ed1997; 64: 59–62. MedlineGoogle Scholar
  • 40 GordonLF, Arger PH, Dalinka MK, Coleman BG. Computed tomography in soft tissue calcification layering. J Comput Assist Tomogr1984; 8: 71–73. Crossref, MedlineGoogle Scholar
  • 41 ChewFS, Maldjian C, Leffler SG. Musculoskeletal imaging: a teaching file. New York, NY: Lippincott Williams & Wilkins, 1999; 326. Google Scholar
  • 42 ChewFS, Roberts CC. Musculoskeletal imaging: a teaching file. 2nd ed. New York, NY: Lippincott Williams & Wilkins, 2006; 314. Google Scholar
  • 43 ChewFS, Roberts CC. Musculoskeletal imaging: a teaching file. 2nd ed. New York, NY: Lippincott Williams & Wilkins, 2006; 496. Google Scholar
  • 44 ChewFS, Roberts CC. Musculoskeletal imaging: a teaching file. 2nd ed. New York, NY: Lippincott Williams & Wilkins, 2006; 31. Google Scholar
  • 45 FlemmingDJ, Murphey MD, Shekitka KM, Temple HT, Jelinek JJ, Kransdorf MJ. Osseous involvement in calcific tendonitis: a retrospective review of 50 cases. AJR Am J Roentgenol2003; 181: 965–972. Crossref, MedlineGoogle Scholar
  • 46 ChewFS, Roberts CC. Musculoskeletal imaging: a teaching file. 2nd ed. New York, NY: Lippincott Williams & Wilkins, 2006; 233. Google Scholar
  • 47 KransdorfMJ, Meis JM. Extraskeletal osseous and cartilaginous tumors of the extremities. RadioGraphics1993; 13: 853–884. LinkGoogle Scholar
  • 48 CadmanNL, Soule EH, Taylor WF. Synovial sarcoma: analysis of 134 tumors. Cancer1965; 18: 613–627. Crossref, MedlineGoogle Scholar
  • 49 MortonMJ, Berquist TH, McLeod RA, Unni KK, Sim FH. MR imaging of synovial sarcoma. AJR Am J Roentgenol1991; 156: 337–340. Crossref, MedlineGoogle Scholar
  • 50 JonesBC, Sundaram M, Kransdorf MJ. Synovial sarcoma: MR imaging findings in 34 patients. AJR Am J Roentgenol1993; 161: 827–830. Crossref, MedlineGoogle Scholar
  • 51 ChewFS, Roberts CC. Musculoskeletal imaging: a teaching file. 2nd ed. New York, NY: Lippincott Williams & Wilkins, 2006; 342. Google Scholar
  • 52 ChewFS, Roberts CC. Musculoskeletal imaging: a teaching file. 2nd ed. New York, NY: Lippincott Williams & Wilkins, 2006; 242. Google Scholar
  • 53 WangJW, Chen WJ. Calcific myonecrosis of the leg: a case report and review of the literature. Clin Orthop Relat Res2001; 389: 185–190. Crossref, MedlineGoogle Scholar
  • 54 KirkTS, Simon MA. Tumoral calcinosis: report of a case with successful medical management. J Bone Joint Surg Am1981; 63: 1167–1169. Crossref, MedlineGoogle Scholar
  • 55 MozaffarianG, Lafferty FW, Pearson OH. Treatment of tumoral calcinosis with phosphorus deprivation. Ann Intern Med1972; 77: 741–745. Crossref, MedlineGoogle Scholar
  • 56 DaviesM, Clements MR, Mawer EB, Freemont AJ. Tumoral calcinosis: clinical and metabolic response to phosphorus deprivation. Q J Med1987; 63: 493–503. MedlineGoogle Scholar
  • 57 YamaguchiT, Sugimoto T, Imai Y, Fukase M, Fujita T, Chihara K. Successful treatment of hyperphosphatemic tumoral calcinosis with long-term acetazolamide. Bone1995; 16(4 suppl): 247S–250S. Crossref, MedlineGoogle Scholar
  • 58 LufkinEG, Wilson DM, Smith LH, et al. Phosphorus excretion in tumoral calcinosis: response to parathyroid hormone and acetazolamide. J Clin Endocrinol Metab1980; 50: 648–653. Crossref, MedlineGoogle Scholar
  • 59 ThomsonJE, Tanner FH. Tumoral calcinosis. J Bone Joint Surg Am1949; 31: 132–135. CrossrefGoogle Scholar
  • 60 NassimJR, Connolly DK. Treatment of calcinosis universalis with aluminum hydroxide. Arch Dis Child1970; 45: 118–121. Crossref, MedlineGoogle Scholar
  • 61 NunleyJR, Jones LME. Calcinosis cutis. http://www.emedicine.com/derm/topic66.htm. Accessed March 23, 2005. Google Scholar
  • 62 EbenbichlerGR, Erdogmus CB, Resch KL, et al. Ultrasound therapy for calcific tendinitis of the shoulder. N Engl J Med1999; 340: 1533–1538. Crossref, MedlineGoogle Scholar
  • 63 AinaR, Cardinal E, Bureau NJ, Aubin B, Brassard P. Calcific shoulder tendonitis: treatment with modified US-guided fine-needle technique. Radiology2001; 221: 455–461. LinkGoogle Scholar

Article History

Published in print: May 2006