Retrospective Study of Seven Patients with Tumoral Calcinosis

Original Article | Volume 6 | Issue 2 | JBST May-August 2020 | Page 12-16 | Kshitij Manerikar, Abhijeet Salunke, Jaymin V. Shah, Mayur Kamani, Shashank Pandya. DOI: 10.13107/jbst.2020.v06i02.25

Author: Kshitij Manerikar[1], Abhijeet Salunke[1], Jaymin V. Shah[1], Mayur Kamani[1], Shashank Pandya[1]

[1]Department of Surgical Oncology, Gujarat Cancer Research and Institute, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Kshitij Manerikar,
A-302, Divyadeep, Ram Mandir Road, TPS-3, Borivali West, Mumbai – 400 092, Maharashtra, India.


Introduction: Calcium deposition in the skin has been termed as calcinosis cutis. Tumoral calcinosis is idiopathic form of calcinosis cutis. Etiology of idiopathic calcinosis cutis is unknown. It is characterized by periarticular deposition of amorphous calcium salts around large joints. Our diligent search through literature could not find any consensus on the etiopathogenesis and treatment modalities for tumoral calcinosis.
Materials and Methods: A retrospective study of seven patients of tumoral calcinosis treated with complete surgical excision over a period of 1 year was done. Demographic details were compiled. Routine blood investigations were performed. All patients underwent radiographs and magnetic resonance imaging (MRI) scans of involved part. We did not perform computed tomography (CT) or bone scan in any of our patients. All seven patients underwent surgery and were followed up till 2 years.
Results: In our study, five were female and two were male patients ranging from 31 to 76 years. Size of swelling varied from 2 to 15 cm. Most common location was hip. Serum calcium, phosphorus, and alkaline phosphatase were normal in all patients. Radiographs showed well-outlined periarticular cluster of calcifications in the soft tissues around joint. MRI revealed round to oval multiple cystic lesions around the affected region, but not involving the joint.
Conclusion: Tumoral calcinosis is always the diagnosis of exclusion. It can be normophosphatemic or hypophosphatemic subtype. Large joints are more commonly affected. One can rely on radiographs for diagnosis. MRI for knowing exact location of lesion, its relationship with adjacent structures and planning of surgery is advocated. Complete surgical excision is the only optimum treatment of tumoral calcinosis.
Keywords: Amorphous calcium phosphate, hyperphosphatemia, X-ray film, hip joint, calcinosis, magnetic resonance imaging.

1. Kluger G, Kochs A, Holthausen H. Heterotopic ossification in childhood and adolescence. J Child Neurol 2000;15:406-13.
2. James W, Berger T, Elston D. Andrews’ Diseases of the Skin: Clinical Dermatology. 11th ed. Philadelphia, PA: Elsevier, Saunders; 2011. p. 516-8.
3. Chaabane S, Chelli-Bouaziz M, Jelassi H, Mrad K, Smida M, Ladeb MF. Idiopathic tumoral calcinosis. Acta Orthop Belg 2008;74:837-45.
4. Muddegowda P, Lingegowda J, Ramachandrarao R, Konapur PG. Calcinosis cutis: Report of 4 Cases. J Lab Physicians 2011;3:125-6.
5. Emery K, Fletcher B. The soft tissues. In: Kuhn JP, Slovis TL, editors. Caffey’s Pediatric Diagnostic Imaging. 10th ed. Philadelphia, PA: Mosby; 2004. p. 2009-11.
6. Inclan A, Leon P, Camejo MG. Tumoral calcinosis. JAMA 1943;121:490-95.
7. Smack D, Norton S, Fitzpatrick J. Proposal for a pathogenesis-based classification of tumoral calcinosis. Int J Dermatol 1996;35:265-71.
8. Noyez J, Murphree S, Chen K. Tumoral calcinosis, a clinical report of eleven cases. Acta Orthop Belg 1993;59:49-54.
9. Aprin H, Sinha A. Tumoral calcinosis: Report of a case in a one year old child. Clin Orthop 1984;185:83-6.
10. Niall D, Fogarty E, Dowling F, Moore D. Spontaneous regression of tumoral calcinosis in an infant: A case report. J Pediatr Surg 1998;33:1429-31.
11. Fujii T, Matsui N, Yamamoto T, Yoshiya S, Kurosaka M. Solitary intra-articular tumoral calcinosis of the knee. Arthroscopy 2003;19:E1.
12. Bittmann S, Gunther M, Ulus H. Tumoral calcinosis of the gluteal region in a child: Case report with overview of different soft-tissue calcifications. J Pediatr Surg 2003;38:E4-7.
13. Rodriguez-Peralto J, Lopez-Barea F, Torres A, Rodriguez-Gonzalez JI, Diaz-Faes J. Tumoral calcinosis in two infants. Clin Orthop 1989;242:272-6.
14. Enzinger F, Weiss S. Soft Tissue Tumours. St Loius: C V Mosby; 1983. p. 906-8.
15. Hruska K, Lederer E. Hyperphosphatemia and hypophosphatemia. In: Favus MJ, editor. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999. p. 246-53.
16. Salutario M, Vogler J, Harrelson J, Lyles K. Imaging of tumoral calcinosis: New observations. Radiology 1990;174:215-22.
17. Martinez S. Tumoral calcinosis: 12 Years later. Semin Musculoskelet Radiol 2002;6:331-9.
18. Martinez S, Vogler J, Harrelson J, Lyles K. Imaging of tumoral calcinosis: New observations. Radiology 1990;174:215-22.
19. Savaci N, Avunduk M, Tosun Z, Hosnuter M. Hyper-phosphatemic tumoral calcinosis. Plast Reconstr Surg 2000;105:162-5.
20. Yamaguchi T, Sugimoto T, Imai Y, Fukase M, Fujita T, Chihara K. Successful treatment of hyperphosphatemic tumoral calcinosis with long-term acetazolamide. Bone 1995;16:247-50.
21. Slavin R, Wen J, Kumar D, Evans E. Familial tumoral calcinosis. A clinical, histopathologic, and ultrastructural study with an analysis of its calcifying process and pathogenesis. Am J Surg Pathol 1993;17:788-802.

How to Cite this article: Manerikar K, Salunke A, Shah JV, Kamani M, Pandya S | Retrospective Study of Seven Patients with Tumoral Calcinosis | Journal of  Bone and Soft Tissue Tumors | May-August 2020; 6(2): 12-16.

[Full Text HTML] [Full Text PDF] [XML]

Parosteal Lipoma of the Lower Limb: A Report of Two Cases

Vol 5 | Issue 1 | Jan-April 2019 | page: 21-24 | Imed Sboui, Hend Riahi, Mouna Chelli-Bouaziz, Mohamed Samir Daghfous, Mohamed Fethi Ladeb, Faten Farah.

Authors: Imed Sboui [1], Hend Riahi [2], Mouna Chelli-Bouaziz[2], Mohamed Samir Daghfous [1], Mohamed Fethi Ladeb [2], Faten Farah [3].

[1] Department of Orthopaedic, Institut Mohamed Kassab d’orthopédie, Manouba, Tunisia,
[2] Department of Radiology, Institut Mohamed Kassab d’orthopédie, Manouba, Tunisia,
[3] Department of Pathology, Institut Mohamed Kassab d’orthopédie, Manouba, Tunisia.

Address of Correspondence
Dr. Hend Riahi,
10 rue Khalifas Rachidites Menzeh 5 Ariana Tunisia.


Introduction: Parosteal lipoma is a rare type of lipoma. Usually, asymptomatic and affecting mainly adults aged over 40.
Case Report: We report two cases localized in the lower limb. The first happened in a man presenting a painless swelling of the fibula, represented by a well-defined fatty tissue lesion. The second case concerned women presenting an asymmetry of the calf, represented by a well-defined mass composed of fatty tissue. The lesions were resected from surrounding soft tissues and underlying periosteum. The diagnosis was confirmed by histology.
Conclusion: Parosteal lipoma has the same characteristics of computed tomography (CT) and magnetic resonance imaging (MRI) as subcutaneous fat. The identification of fat is best performed with CT or MRI. Its recognition is mandatory to optimize clinical management including diagnosis, biopsy, and treatment.
Keywords: Deep-seated lipoma, Computed tomography, Magnetic resonance imaging.


1. Fleming RJ, Alpert M, Garcia A. Parosteal lipoma. AJR Am J Roentgenol 1962;87:1075-84.
2. Rodriguez-Peralto JL, Lopez-Barea F, Gonzales-Lopes J, Lamas-Lorenzo M. Case report 821. Skeletal Radiol 1994;23:67-9.
3. Asirvatham R, Linjawi T. Ossifying parosteal lipoma with exuberant cortical reaction. A case report. Int Orthop 1994;18:55-6.
4. Amores-Ramírez F, Hierro Martín I, Montañez Heredia E, Garcia-Fortea P, Garcia Salguero AI, Fernandez de Rota Conde A, et al. Painless mass in leg: Diagnosis and discussion. Skeletal Radiol 2009;38:1105-6, 1119-20.
5. Murphey MD, Johnson DL, Bhatia PS, Neff JR, Rosenthal HG, Walker CW, et al. Parosteal lipoma: MR imaging characteristics. AJR Am J Roentgenol 1994;162:105-10.
6. Schajowicz F. Neoplasia Óssea e Lesões Pseudotumorais. 2nd ed. Rio de Janeiro: Revinter; 2000. p. 403-46.
7. John SH, Chad CB, Kathleen SB, Valerie AF, Marcia FB, Joseph B. Parosteal lipoma of the proximal radius. Austin J Musculoskelet Disord 2016;3:1027.
8. Murphey MD, Arcara LK, Fanburg-Smith J. From the archives of the AFIP: Imaging of musculoskeletal liposarcoma with radiologic-pathologic correlation. Radiographics 2005;25:1371-95.
9. Murphey MD, Carroll JF, Flemming DJ, Pope TL, Gannon FH, Kransdorf MJ, et al. From the archives of the AFIP: Benign musculoskeletal lipomatous lesions. Radiographics 2004;24:1433-66.
10. Greco M, Mazzocchi M, Ribuffo D, Dessy LA, Scuderi N. Parosteal lipoma. Report of 15 new cases and a review of the literature. Ann Ital Chir 2013;84:229-35.
11. Rosenberg AE, Bridge JA. Lipoma of bone. In: Fletcher CD, Unni KK, Mertens F, editors. Pathology and Genetics of Tumours of the Soft Tissues and Bones. Lyon: IARC Press; 2002. p. 328-9.
12. Kawashima A, Magid D, Fishman EK, Hruban RH, Ney DR. Parosteal ossifying lipoma: CT and MR findings. J Comput Assist Tomogr 1993;17:147-50.
13. Seki N, Okada K, Miyakoshi N, Shimada Y, Nishida J, Itoi E, et al. Common peroneal nerve palsy caused by parosteal lipoma of the fibula. J Orthop Sci 2006;11:88-91.
14. Resnick D, editor. Tumor and tumor-like diseases. In: Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia, PA: Saunders; 1995. p. 3745-4128.
15. Dorfman HD. Miscellaneous mesenchymal tumors. In: Dorfman H, Czerniak B, editors. Bone Tumors. St Louis, Mo: Mosby; 1998. p. 913-48.
16. Petit MM, Swarts S, Bridge JA, Van de Ven WJ. Expression of reciprocal fusion transcripts of the HMGIC and LPP genes in parosteal lipoma. Cancer Genet Cytogenet 1998;106:18-23.
17. Kransdorf M, Murphey M. Lipomatous tumors. In: Imaging of Soft Tissue Tumors. Philadelphia, PA: Saunders; 1997. p. 57-101.
18. Obermann EC, Bele S, Brawanski A, Knuechel R, Hofstaedter F. Ossifying lipoma. Virchows Arch 1999;434:181-3.
19. Burt AM, Huang BK. Imaging review of lipomatous musculoskeletal lesions. SICOT J 2017;3:34.
20. Yu JS, Wei L, Becker W. MR imaging of a parosteal lipoma. J Clin Imaging 2000;24:15-8.
21. Balani A, Sankhe A, Dedhia T, Bhuta M, Lakhotia N, Yeshwante J, et al. Lump on back: A rare case of parosteal lipoma of scapula. Case Rep Radiol 2014;2014:169157.
22. Go T, Nakajima N, Yokota N, Yokomise H. Thoracoscopic resection of parosteal lipoma of the rib using orthopedic electric micro drill. Gen Thorac Cardiovasc Surg 2018;66:675-8.

How to Cite this article: Sboui I, Riahi H, Chelli-Bouaziz M, Daghfous MS, Ladeb MF, Farah F. Parosteal Lipoma of the Lower Limb: A Report of Two Cases. Journal of Bone and Soft Tissue Tumors Jan-Apr 2019;5(1): 21-24.

                  (Abstract    Full Text HTML)   (Download PDF)

Current Concepts in Imaging of Giant Cell Tumor of Bone

Volume 3 | Issue 1 | May – Aug 2017 | Page 3-7 | Khushboo Pilania, Bhavin Jankharia

Authors: Khushboo Pilania [1], Bhavin Jankharia [1].

[1]Consultant Radiologists, Picture This by Jankharia, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Bhavin Jankharia,
Bhaveshwar Vihar, 383 S V P Rd,
Mumbai – 400004, Maharashtra, India.


Giant cell tumor(GCT) of bone is a tumor of giant cell proliferation that usually affects men and women in the thirdand fourthdecades. Typical cases have straight-forward imaging appearances. Atypical cases may resemble many other benign and sometimes malignant lesions. Plain radiographs and magnetic resonance imaging (MRI) are the mainstay of diagnosis, followed by biopsy and histology.Positron emission tomography/computed tomography (CT) has a limited role to play.Aneurysmal bone cyst transformation within GCTs is known. This may change the imaging appearance. GCTs may be multifocal, locally aggressive, and may metastasize to nodes and lungs.Treatment with drugs like denosumab also changes the appearance on radiographs and MRI. Post-operative imaging can be a challenge, and picking up recurrence also requires high-quality radiographs, MRIs, and CT scans.
Keywords: Giant cell tumor, giant cell tumor, bone neoplasm, computed tomography scan, magnetic resonance  imaging, plain radiograph.


1. Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR Jr, et al. Giant cell tumor of bone: Review, mimics, and new developments in treatment. Radiographics 2013;33:197-211.
2. Dorfman HD, Czerniak B. Giant-cell lesions. In: Dorfman HD, Czerniak B, editors. Bone Tumors. St Louis, Mo: Mosby; 1998. p. 559-606.
3. Stacy GS, Peabody TD, Dixon LB. Mimics on radiography of giant cell tumor of bone. AJR Am J Roentgenol 2003;181:1583-9.
4. Cooper AS, Travers B. Surgical Essays. London, England: Cox Longman & Co.; 1818.
5. Murphey MD, Nomikos GC, Flemming DJ, Gannon FH, Temple HT, Kransdorf MJ, et al. From the archives of AFIP. Imaging of giant cell tumor and giant cell reparative granuloma of bone: Radiologic-pathologic correlation. Radiographics 2001;21:1283-309.
6. Manaster BJ, Doyle AJ. Giant cell tumors of bone. Radiol Clin North Am 1993;31:299-323.
7. Moser RP Jr., Kransdorf MJ, Gilkey FW, Manaster BJ. From the archives of the AFIP. Giant cell tumor of the upper extremity. Radiographics 1990;10:83-102.
8. Puri A, Agarwal MG, Shah M, Jambhekar NA, Anchan C, Behle S, et al. Giant cell tumor of bone in children and adolescents. J Pediatr Orthop 2007;27:635-9.
9. Joyner CJ, Quinn JM, Triffitt JT, Owen ME, Athanasou NA. Phenotypic characterization of mononuclear and multinucleated cells of giant cell tumor of bone. Bone Miner 1992;16:37-48.
10. Frassica FJ, Sanjay BK, Unni KK, McLeod RA, Sim FH. Benign giant cell tumor. Orthopedics 1993;16:1179-83.
11. Kafchitsas K, Habermann B, Proschek D, Kurth A, Eberhardt C. Functional results after giant cell tumor operation near knee joint and the cement radiolucent zone as indicator of recurrence. Anticancer Res 2010;30:3795-9.
12. Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am 2006;37:35-51.
13. Arnold RT, van Holsbeeck MT, Mayer TG, Mott MP, Koch SR. Best cases from the AFIP: Necrotic giant cell tumor of bone manifesting with pathologic fracture. Radiographics 2011;31:93-8.
14. Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, et al. Giant cell tumor of long bone: A Canadian sarcoma group study. Clin Orthop Relat Res 2002;397:248-58.
15. Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP. Giant cell tumor of bone. Am J Clin Oncol 2006;29:96-9.
16. Dahlin DC. Caldwell lecture. Giant cell tumor of bone: Highlights of 407 cases. AJR Am J Roentgenol 1985;144:955-60.
17. Bandyopadhyay R, Biswas S, Bandyopadhyay SK, Ray MM. Synchronous multicentric giant cell tumor. J Cancer Res Ther 2010;6:106-8.
18. Dhillon MS, Prabhudev Prasad A, Virk MS, Aggarwal S. Multicentric giant cell tumor involving the same foot: A case report and review of literature. Indian J Orthop 2007;41:154-7.
19. Varshney A, Rao H, Sadh R. Multicentric GCT of tarsal bones in an immature skeleton: A case report with review of literature. J Foot Ankle Surg 2010;49:399.
20. Novais EN, Shin AY, Bishop AT, Shives TC. Multicentric giant cell tumor of the upper extremities: 16 years of ongoing disease. J Hand Surg Am 2011;36:1610-3.
21. Okamoto Y, Mathew S, Daw NC, Neel MD, McCarville MB, Dome JS, et al. Giant cell tumor of bone with pulmonary metastases. Med Pediatr Oncol 2003;41:454-9.
22. Diel J, Ortiz O, Losada RA, Price DB, Hayt MW, Katz DS, et al.The sacrum: Pathologic spectrum, multimodality imaging, and subspecialty approach. Radiographics 2001;21:83-104.
23. Smith J, Wixon D, Watson RC. Giant-cell tumor of the sacrum. Clinical and radiologic features in 13 patients. J Can Assoc Radiol 1979;30:34-9.
24. Kwon JW, Chung HW, Cho EY, Hong SH, Choi SH, Yoon YC, et al. MRI findings of giant cell tumors of the spine. AJR Am J Roentgenol 2007;189:246-50.
25. Anchan C. Giant cell tumor of bone with secondary aneurysmal bone cyst. Int J Shoulder Surg 2008;2:68.
26. Kransdorf MJ, Sweet DE. Aneurysmal bone cyst: Concept, controversy, clinical presentation, and imaging. AJR Am J Roentgenol 1995;164:573-80.
27. Murphey MD, Flemming DJ, Torop AH, Smith SE, Sonin AH, Temple HT. Imaging differentiation of primary and secondary aneurysmal bone cyst with pathologic correlation (abstr). Radiology 1998;209:311.
28. Libicher M, Bernd L, Schenk JP, Mädler U, Grenacher L, Kauffmann GW, et al. Characteristic perfusion pattern of osseous giant cell tumor in dynamic contrast-enhanced MRI. Radiologe 2001;41:577-82.
29. O’Connor W, Quintana M, Smith S, Willis M, Renner J. The hypermetabolic giant: 18F-FDG avid giant cell tumor identified on PET-CT. J Radiol Case Rep 2014;8:27-38.
30. Costelloe CM, Chuang HH, Madewell JE. FDG PET/CT of primary bone tumors. AJR Am J Roentgenol 2014;202:W521-31.
31. Tian R, Su M, Tian Y, Li F, Li L, Kuang A, et al.Dual-time point PET/CT with F-18 FDG for the differentiation of malignant and benign bone lesions. Skeletal Radiol 2009;38:451-8.
32. Salzer-Kuntschik M. Differential diagnosis of giant cell tumor of bone. Verh Dtsch Ges Pathol 1998;82:154-9.
33. Nedopil A, Raab P, Rudert M. Desmoplastic fibroma: A case report with three years of clinical and radiographic observation and review of the literature. Open Orthop J 2013;8:40-6.
34. Gong YB, Qu LM, Qi X, Liu JG. Desmoplastic fibroma in the proximal femur: A case report with long-term follow-up. Oncol Lett 2015;10:2465-7.
35. Pavlovic S, Valyi-Nagy T, Profirovic J, David O. Fine-needle aspiration of brown tumor of bone: Cytologic features with radiologic and histologic correlation. Diagn Cytopathol 2009;37:136-9.
36. Liu PT, Valadez SD, Chivers FS, Roberts CC, Beauchamp CP. Anatomically based guidelines for core needle biopsy of bone tumors: Implications for limb-sparing surgery. Radiographics 2007;27:189-205.
37. O’Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ, et al. Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg Am 1994;76:1827-33.
38. Lee FY, Montgomery M, Hazan EJ, Keel SB, Mankin HJ, Kattapuram S, et al. Recurrent giant-cell tumor presenting as a soft-tissue mass. A report of four cases. J Bone Joint Surg Am 1999;81:703-7.
39. Remedios D, Saifuddin A, Pringle J. Radiological and clinical recurrence of giant-cell tumour of bone after the use of cement. J Bone Joint Surg Br 1997;79:26-30.
40. Thomas D, Henshaw R, Skubitz K, Chawla S, Staddon A, Blay JY, et al. Denosumab in patients with giant-cell tumour of bone: An open-label, phase 2 study. Lancet Oncol 2010;11:275-80.
41. Hakozaki M, Tajino T, Yamada H, Hasegawa O, Tasaki K, Watanabe K, et al.Radiological and pathological characteristics of giant cell tumor of bone treated with denosumab. Diagn Pathol 2014;9:111.
42. Unni KK. Dahlin’s Bone Tumors: General Aspects and Data on 11,087 Cases. 5th ed. Philadelphia, PA: Lippincott-Raven; 1996.

How to Cite this article:  Pilania K, Jankharia B. Current Concepts in Imaging of Giant Cell Tumor of Bone. Journal of Bone and Soft Tissue Tumors May-Aug 2017;3(1): 2-6.


 (Abstract    Full Text HTML)      (Download PDF)