ABSTRACT
Subepidermal Calcified Nodule of Ear is an uncommon lesion which is a type of Idiopathic Calcinosis Cutis. It is characterised by calcium deposits in an otherwise normal tissue with no underlying defects in Calcium or phosphorus homeostasis. With an unknown etiopathogenesis, it is usually seen in the paediatric age group. Final diagnosis need a clinicopathological correlation and it underlines the importance of post operative lab investigations which the patient must undergo to rule out any other underlying pathology. We present case of an 8 year old girl with subepidermal calcified nodule of left ear auricle which is a rare occurrence.
ABSTRACT
BACKGROUND: Subepidermal calcified nodule (SCN) is a type of calcinosis cutis that usually occurs in children. The lesions in the SCN resemble those of other skin diseases, such as pilomatrixoma, molluscum contagiosum, and juvenile xanthogranuloma, leading to a high rate of misdiagnoses. Noninvasive in vivo imaging techniques, represented by dermoscopy and reflectance confocal microscopy (RCM), have dramatically accelerated skin cancer research over the past decade, and their applications have greatly expanded into other skin disorders. However, the features of an SCN in dermoscopy and RCM have yet to be reported previously. Combining these novel approaches with conventional histopathological examinations is a promising method for increasing diagnostic accuracy. CASE PRESENTATION: We report on a case of SCN of the eyelid diagnosed with the aid of dermoscopy and RCM. A 14-year-old male patient who presented with a painless yellowish-white papule on his left upper eyelid was previously diagnosed with a common wart. Unfortunately, treatment with recombinant human interferon gel was not effective. To achieve a correct diagnosis, dermoscopy and RCM were performed. The former showed closely grouped multiple yellowish-white clods surrounded by linear vessels, and the latter exhibited hyperrefractile material nests at the dermal-epidermal junction level. The alternative diagnoses were, therefore, excluded because of in vivo characterizations. Subsequent surgical excision, histological examination, and von Kossa staining were performed. Pathology showed hyperkeratosis of the epidermis, a downward-directed basal-layer expansion, and small amorphous basophilic deposits scattered throughout the papillary dermis. The von Kossa staining confirmed calcium deposits in the lesion. An SCN was then diagnosed. During the 6-month follow-up, no relapse was observed. CONCLUSIONS: Patients with SCN could benefit from dermoscopy and RCM, which help achieve an accurate diagnosis. Clinicians should consider the possibility of an SCN for an adolescent patient with painless yellowish-white papules.
Subject(s)
Calcinosis Cutis , Dermoscopy , Adolescent , Child , Male , Humans , Skin , Calcium , Microscopy, ConfocalABSTRACT
Calcinosis cutis (CC) is characterized by calcium deposition in the subcutaneous tissues. Subepidermal calcified nodule (SCN) is a variant of idiopathic calcinosis most commonly seen in the head and neck region of children and adolescents as a single, small, painless, yellow-white papule. A 13-year-old boy with a medical history of neurofibromatosis type 1 (NF1) presented with a firm 0.3 cm white papule in the lower eyelid. He also had neurofibromas of the left forearm and spinal cord, and a malignant peripheral nerve sheath tumor of the right forearm. The eyelid lesion showed hyperkeratotic epidermis, papillomatosis, and elongated rete ridges, with a radial arrangement at the periphery of the well-circumscribed lesion comprising many dystrophic calcifications, histiocytes, and foreign body giant cell reactions. To our knowledge, this is the first case of SCN reported in the context of NF1 or any other systemic disease in the English literature. Although a coincidence is likely, rare observations of the parathyroid gland and calcium metabolism disorders in association with NF1 may provide an explanation that requires further investigation.
ABSTRACT
Subepidermal calcified nodule (SCN) is a rare presentation of idiopathic calcinosis cutis. A literature review was conducted, with 109 cases reported in 268 articles. We report the demographic data, SCN clinical and histological characteristics, common differential diagnoses, and treatments performed from this analysis.
Subject(s)
Calcinosis , Skin Neoplasms , Calcinosis/diagnosis , Diagnosis, Differential , Humans , SkinABSTRACT
Calcinosis cutis involves the inappropriate deposition of calcium within the dermis layer of the skin and is often associated with autoimmune diseases. A 3-year-old healthy Omani child presented for evaluation of asymptomatic hard nodule on the left upper eyelid. Pathological examination identified the mass as subepidermal calcified nodule. The patient had no history of trauma or metabolic disturbances. Serum levels of calcium and phosphate were normal. Idiopathic calcinosis cutis should be included in the differential diagnosis for eye lid mass.
ABSTRACT
A subepidermal calcified nodule is an uncommon variant of calcinosis cutis and only a limited number of cases have been reported about the eyelid nodules in the literature. A 20-year-old male was referred to our department with symmetrical nodules on both upper eyelids enlarging over 3 years. Both nodules were removed by excisional biopsy. After the histopathologic evaluation, the diagnosis was subepidermal calcified nodule. He had a complete recovery with no recurrence and acceptable aesthetic appearance. As a rare entity, subepidermal calcified nodule should be thought in differential diagnosis of eyelid nodular lesions and symmetrical appearance may be seen.
Subject(s)
Calcinosis/pathology , Eyelid Diseases/pathology , Calcinosis/surgery , Eyelid Diseases/surgery , Humans , Male , Young AdultABSTRACT
Subepidermal calcified nodule is a rare form of calcinosis cutis, which is not associated with any dermatologic or systemic diseases, and usually presents as a solitary hard nodule on the face or neck of children. A 25-month-old boy had a small pea-sized, tender nodule on his left sole that had been present for several months. There was no history of previous trauma or systemic illness. The clinical diagnosis as a viral wart was initially made and treated with cryotherapy. Because the lesion was not clear and a yellow-white firm papule was seen after cryotherapy, punch excision was done. Histologic examination showed cystic structure with calcium deposition in the upper dermis. Herein, we present the findings of a patient with a rare, solitary subepidermal calcified nodule on the sole.
Subject(s)
Child , Child, Preschool , Humans , Male , Calcinosis , Calcium , Cryotherapy , Dermis , Diagnosis , Neck , WartsABSTRACT
Subepidermal calcified nodule is an unusual type of idiopathic calcinosis cutis and usually presents as an asymptomatic, solitary, firm, verrucous, white or yellowish nodule. It commonly occurs in young children, generally on the face and neck, especially eyelid, cheek. However, sole is a very rare site. Four patients presented with several months??history of solitary 2~3 mm sized firm nodule on the sole. Three of the patients were less than 1 year old, with no history of trauma. Histopathologic examination revealed hyperkeratosis, acanthosis and amorphous basophilic material in cystic space beneath the epidermis, meaning deposition of calcium salt. These histopathologic features were consistent with subepidermal calcified nodule. Serum calcium and phosphorus levels of the patients were within normal limits. Herein, we present 4 cases of subepidermal calcified nodule on the sole, an atypical location.
Subject(s)
Child , Humans , Basophils , Calcinosis , Calcium , Cheek , Epidermis , Eyelids , Neck , PhosphorusABSTRACT
Calcinosis cutis is a rare disease characterized by deposition of insoluble calcium salts in the skin. Subepidermal calcified nodule is a form of idiopathic calcinosis cutis that commonly affects children but rarely presents at birth. Herein we describe a healthy 10-month-old boy who had a solitary hard nodule on the left foot since birth. Surgical excision of the nodule was done and histopathology confirmed the diagnosis of subepidermal calcified nodule.
ABSTRACT
Calcinosis cutis is a condition of accumulation of calcium salts within the dermis. We are presenting four cases of calcinosis cutis, with different clinical presentations, occurring in healthy individuals, with normal serum calcium and phosphorus levels. Histologically, all cases showed similar morphology, the lesions were composed of large and small deposits of calcium. Foreign-body giant cell reaction was seen in one case. Another case had intact and ruptured epidermal cysts and calcification within the cyst.
ABSTRACT
Subepidermal calcified nodule, a subset of calcinosis cutis, is usually presented as single small, raised, hard nodule. Histologically calcium deposition can be detected by von Kossa or periodic acid-Schiff stain. We report a 3-year-old boy who had erythematous hyperkeratotic plaques and papules on both inner thighs without any previous history of trauma, genetic or systemic illness. A biopsy specimen of plaque of the thigh showed the transepidermal elimination of basophilic granules which were dispersed in the upper dermis and von Kossa stain revealed scattered calcific deposition.
Subject(s)
Child, Preschool , Humans , Male , Basophils , Biopsy , Calcinosis , Calcium , Dermis , ThighABSTRACT
Subepidermal calcified nodule is a rather uncommon, but peculiar subtype of calcinosis cutis. It presents as a single asymptomatic, hard, yellowish white nodule which commonly occurs on the face of children. Histopathologic examination reveals the multifocal various-sized papillary dermal collection of dark blue amorphous globular deposits confirmed by von Kossa stain for calcium. We report a 42-year-old man who had small white hyperkeratotic papule on finger tip for more than 20 years. He could recall neither preceding trauma nor systemic illness. Excisional biopsy, with the clinical impression of verruca or corn, showed typical histopathologic features of the subepidermal calcified nodule.
Subject(s)
Adult , Child , Humans , Biopsy , Calcinosis , Calcium , Fingers , Warts , Zea maysABSTRACT
The subepidermal calcified nodule, also known as a form of calcinosis cutis, is characterized by solitary circumscribed deposits of insoluble calcium within the subepidermis. The disease is not associated with any systemic or cutaneous diseases, or any biochemical abnormalities. The pathogenesis is still unknown. A 55-year-old female presented with a 4-month history of solitary skin-colored, hyperkeratotic papule on the left upper eyelid. The lesion was asymptomatic and had increased slowly in size. It is interesting that excisional biopsy showed typical histopathologic features of the subepidermal calcified nodule and the clear cell syringoma.
Subject(s)
Female , Humans , Middle Aged , Biopsy , Calcinosis , Calcium , Eyelids , SyringomaABSTRACT
Subepidermal calcified nodule, a form of idiopathic calcinosis cutis, typically present as a hard, 3 to 11 mm, solitary lesion on the exposed area of the head and the extremities. Here we re-port an unusual case of subepidermal calcified nodule occurring on the buttock. A 15-year-old girl presented with a 6-month history of a 12 × 6 mm, oval, hard, erythematous nodule on the right buttock. Histopathologic examination of an excision biopsy specimen revealed extensive deposition of calcium in the whole dermis as large multilobulated masses.
Subject(s)
Adolescent , Female , Humans , Biopsy , Buttocks , Calcinosis , Calcium , Dermis , Extremities , HeadABSTRACT
Subepidermal calcified nodule(SCN) is a form of calcinosis cutis which is usually present as a single small, raised, hard nodule with verrucous surface. A 13-year-old girl presented with a 10-month history of a ricegrain-sized, hard, yellowish white papule on both upper eyelids. The lesions were asymptomatic and had increased slowly in size. An excisional biopsy specimen of the left upper eyelid showed acanthosis and narrow pointed rete ridges of the epidermis, and closely aggregated deposition of basophilic material in the uppermost dermis. The material in the dermis did not stain with von Kossa. It was confirmed as calcium deposition by staining with alizarin red S which is far more specific for calcium than the von Kossa stain.
Subject(s)
Adolescent , Female , Humans , Basophils , Biopsy , Calcinosis , Calcium , Dermis , Epidermis , EyelidsABSTRACT
Subepidermal calcified nodule, a form of calcinosis cutis, usually occurs as a solitary lesion and develops in early childhood. We report a 20-month-old boy with an unusual form of subepidermal calcified nodules on both palms and soles which were multiple and present at birth. Interestingly, his uncle had similar lesions during infancy which had shown spontaneous remission.
