Calcinosis Cicumscripta

Calcinosis Circumscripta

Uncommon syndrome of ectopic idiopathic, dystrophic, metastatic or iatrogenic mineralization

Human beings Circumscripta Universalis

Monkeys, dogs, cats, horses, cows, a buffalo, a rabbit and a captive sitatunga

Calcinosis Circumscripta

The pathogenesis not completely understood calcium salts are deposited in soft tissues in the form of

hydroxyapatite or amorphous calcium phosphateMultiple theories in human orthopedics

repetitive trauma leading to reparative dysfunction periarticular forces dissecting histiocytic aggregates that

initiate osteoclastic activity hemorrhage from microtrauma causing an exaggerated

reparative response.Classified into four major types according to the type of

calcification process and etiology Dystrophic, metastatic, idiopathic, iatrogenic

DystrophicNormal serum calcium and phosphate levels Calcification localized to a specific area of

tissue damagePrimary lesion can be due to injury, necrosis,

inflammation or neoplasia following severe chronic inflammation (reaction to a

foreign body, otitis externa, interdigital pyoderma, demodicosis, neoplasia , apocrine gland degeneration)

IatrogenicArises secondary to a treatment or surgical

procedureCalcification occurring at the invasive site

can also be classified as dystrophic calcificationmedroxyprogestrone and proligestone

injectionspolidioxanone suture material

MetastaticMost often form in human beingsAbnormal calcium or phosphate metabolism-

hypercalcaemia and/or hyperphosphataemia chronic renal failure,end stage kidney disease, vitamin

D toxicosis. Few reports in the veterinary literature

describe calcinosis circumscripta in association with renal failure calcification of foot pads widespread visceral and vascular mineralization also

reported

IdiopathicOccurs in the absence of known tissue injury

or systemic metabolic defect No causative factor identified

Breed and familial predilection can occur Can be inherited as an autosomal recessive trait in

humans Hereditary predilection has been suggested in dogs

Several cases of idiopathic paravertebral calcinosis circumscripta in dogs and human beings Especially cervical spine

Small Animals

Dystrophic and idiopathic forms occur more frequently than the metastatic form

Idiopathic seen most commonly in young, large breed dogs German Shepherds predisposed Paravertebral cervical

77 dogs without renal diseaseMost common in young dogsLesions solitary in 82% of the affected dogs, and occurred

most commonly on the hind feet (50%) and tongue (23%) Multiple other sites including intestinal (1)

Surgical resection curative

Metastatic

HorsesReferred to calcinonosis circumscripta or

tumoural calcinosis Tumoural calcinosis, a hereditary metabolic

dysfunction of phosphate regulation resulting in massive periarticular calcinosis in humans

Horses are rarely lame

HorsesMost commonly lateral aspect of femorotibial joint

sometimes bilaterally can be closely assoc with joint capsule

Neck, carpus and tarsusDocumented invasion in middle carpal joint and

antebrachiocarpal joint. Thought to be of traumatic origin resulting in dystrophic

mineralization ddx Synovial Osteochondromatosis

Uncommon disorder characterized by the formation of multiple, intra-articular, cartilaginous nodules in the synovial membrane as well as metaplasia of subsynovial connective tissues

these lesions commonly undergo secondary ossification and calcification

References

Calcinosis Circumscripta in the Dog: A Retrospective Pathological Study A. K. Tafti, P. Hanna, A. C. Bourque. J. Vet. Med. A(2005) 52: 13–17

Calcinosis circumscripta in the horse, P. I. Milner Equine vet. Educ. (2009) 21 (11): 589

Calcinosis Circumscripta of the Tongue S. W. Douglas, D. F. Kelly. small anim. Pract. (1966) 7:441 -443.

Calcinosis Circumscripta (Calcium Gout) in related Irish Wolfhounds L. N. Owen. small Anim. Pract. (1967) 8: 291-292.

Calcinosis circumscripta following an injection of proligestone in a Burmese cat CR O’Brien, JS Wilkie. Aust Vet J (2001)79:187-189