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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 11  |  Issue : 1  |  Page : 91-92  

Gargantuan primary scrotal calcinosis – Surgical, cosmetic, and sociopsychiatric concern


1 Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
2 Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Submission18-Feb-2018
Date of Acceptance04-Sep-2018
Date of Web Publication21-Jan-2019

Correspondence Address:
Dr. Poonam Elhence
Department of Pathology, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
India
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DOI: 10.4103/UA.UA_24_18

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   Abstract 

A 47-year-old healthy male had a scrotal lesion for about 10 years which was gradually increasing in size and not associated with pain or tenderness. It was dwarfing the penis and attained its present size of 14 cm × 7.5 cm × 6 cm. There were no discharging sinuses, tenderness, or ulceration. He had no significant past or family history. Laboratory examination revealed unremarkable serum calcium, serum phosphate, serum total protein, serum uric acid, and serum parathormone levels. A clinical diagnosis of epidermal inclusion cysts was suggested. The lesion was entirely excised and sent for histopathologic examination.

Keywords: Gargantuan, primary scrotal calcinosis, surgical treatment


How to cite this article:
Elhence P, Chaudhary R. Gargantuan primary scrotal calcinosis – Surgical, cosmetic, and sociopsychiatric concern. Urol Ann 2019;11:91-2

How to cite this URL:
Elhence P, Chaudhary R. Gargantuan primary scrotal calcinosis – Surgical, cosmetic, and sociopsychiatric concern. Urol Ann [serial online] 2019 [cited 2019 Feb 21];11:91-2. Available from: http://www.urologyannals.com/text.asp?2019/11/1/91/246116


   Introduction Top


Calcinosis has been described at several sites and due to various reasons like increased parathormone and calcium levels, in tumours, in scars and areas of necrosis. Calcinosis in the genital region is uncommon. Lesions in the scrotum present as one to multiple hard nodules which may ulcerate the skin and cause a chalky white discharge. Initially, scrotal calcinosis was thought to be idiopathic in origin. Now it is surmised to arise either from calcification in a pre-existing epidermoid cyst or due to calcification of contents of dilated eccrine glands in the dermis. We describe the case of an adult male with one such gargantuan lesion in the scrotum.


   Case Report Top


A 47-year-old healthy male had a scrotal lesion for about 10 years which was gradually increasing in size and not associated with pain or tenderness. It was dwarfing the penis and attained its present size of 14 cm × 7.5 cm × 6 cm [Figure 1], [Figure 2]. The lesion was entirely excised and sent for histopathologic examination.
Figure 1: Scrotal lesion dwarfing the penis

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Figure 2: Excised scrotal lesion, 14 cm × 7.5 cm × 6 cm

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Microscopic examination of 5-μ thick hematoxylin and eosin (H and E)-stained sections showed skin with unremarkable epidermis with multiple foci of dystrophic calcification and focal foreign body multinucleated giant cell reaction in the dermis, consistent with massive idiopathic scrotal calcinosis [Figure 3] and [Figure 4]. Scrotal calcinosis is a rare benign condition of unknown etiopathogenesis presenting with multiple, firm-to-hard scrotal swellings. Surgical excision with scrotoplasty is an effective treatment modality, though the lesion may recur. The patient is on follow-up for 2 years with no recurrence [Figure 5].
Figure 3: Skin with unremarkable epidermis with multiple foci of dystrophic calcification (H and E, 2x)

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Figure 4: Multiple foci of dystrophic calcification with foreign-body multinucleated giant cell reaction (H and E, 10x)

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Figure 5: Postoperative at 4 months, healed scrotal scar

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   Discussion Top


Scrotal calcinosis is a rare, benign, enigmatic, and disfiguring lesion which is a cause for social and psychiatric concern.[1] Multiple, slow-growing, firm-to-hard, yellowish-white nodules of varying sizes are seen in the dermis of the scrotal skin.[2],[3] These nodules are calcified and associated with foreign-body giant cell reaction. The etiopathogenesis is controversial with some authors favoring origin from calcification of preexisting structures as in the epidermal cysts and others favoring its idiopathic nature.[3],[4]

Surgical excision with scrotoplasty is an effective treatment modality, though they may recur.[3],[5] The patient is on follow-up for 2 years with no recurrence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Pompeo A, Molina WR, Pohlman GD, Sehrt D, Kim FJ. Idiopathic scrotal calcinosis: A rare entity and a review of the literature. Can Urol Assoc J 2013;7:E439-41.  Back to cited text no. 1
    
2.
Hoscan MB, Akkaya H, Tunckiran A, Durusoy C. Massive idiopathic scrotal calcinosis. Urology 2012;80:712.  Back to cited text no. 2
    
3.
Karaca M, Taylan G, Akan M, Eker G, Gideroglu K, Gul AE, et al. Idiopathic scrotal calcinosis: Surgical treatment and histopathologic evaluation of etiology. Urology 2010;76:1493-5.  Back to cited text no. 3
    
4.
Georges Joshué AD, Michaël MA, Malick D, Inès Dodji YM, Gilles N, Jeans S, et al. Massive scrotal calcinosis: Case report. Med Sur Urol 2017;6:185.  Back to cited text no. 4
    
5.
Arora B. Idiopathic scrotal calcinosis: A dermatosurgical disease. Int J Case Rep Imag 2016;7:221-3.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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