Penis & scrotum

Inflammatory

Scrotal calcinosis



Last author update: 25 April 2023
Last staff update: 30 November 2023

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PubMed Search: Scrotal calcinosis

Zeeshan Uddin, M.B.B.S.
Nasir Ud Din, M.B.B.S.
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Cite this page: Uddin Z, Ud Din N. Scrotal calcinosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/penscrotumidiopathiccalcinosis.html. Accessed May 19th, 2024.
Definition / general
Essential features
  • Clinically, multiple subcutaneous painless nodules in scrotum
  • Multiple varying sized calcified deposits in the dermis and subcutis
  • Rarely shows extensive involvement of the scrotum
Terminology
  • Previously described as idiopathic scrotal calcinosis
  • First described by Lewinski in 1883 and was established as a distinct entity by Shapiro et al. in 1970 (Ann Dermatol 2018;30:236)
ICD coding
  • ICD-10:
    • L94.2 - calcinosis cutis
    • E83.59 - other disorders of calcium metabolism
Epidemiology
  • Lesions begin in childhood or early adulthood
  • Mean age of 31.5 years, 70% in 30s to 40s, range of 15 - 77 years (Dermatol Online J 2010;16:5)
Sites
Etiology
  • Pathogenesis of scrotal calcinosis remains unknown and has been the subject of longterm controversy (Urol Case Rep 2020;32:101225)
  • Originally termed idiopathic scrotal calcinosis (ISC); however, many authors suggest that at least some cases are not genuinely idiopathic
  • Dubey et al. evaluated 100 cases, out of which 53% had associated cysts containing calcific material (Dermatol Online J 2010;16:5)
  • Shah et al. found cyst walls in 14 out of 20 cases and suggested that scrotal calcinosis results from calcification of hair follicle or epidermal cysts but as reported in most of the cases, this epithelium disappears and may not be seen (Am J Dermatopathol 2007;29:172)
  • The following are various hypotheses for the origin of scrotal calcinosis:
Clinical features
Diagnosis
Radiology description
  • Ultrasound: typically appear as round or oval echogenic foci with or without acoustic shadowing in cases of large and small calculi, respectively (J Ultrasound Med 2007;26:1775)
Radiology images

Contributed by Nasir Ud Din, M.B.B.S.

Incidentally found scrotal calcinosis

Prognostic factors
  • Nonneoplastic lesions with little chance of recurrence following localized excision
Case reports
Treatment
Clinical images

Images hosted on other servers:

Scrotal calcinosis with vitiligo

Pre and postoperative scrotum

Scrotal skin showing calcifications

Multiple white scrotal nodules

Gross description
Gross images

Contributed by Debra Zynger, M.D.
White nodule

White nodule

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Nasir Ud Din, M.B.B.S., Debra Zynger, M.D. and @katcollmd on Twitter

Skin tissue showing calcium deposits

Multiple calcium deposits

Calcium deposits with granulomatous reaction

Dermal calcium deposits with epidermis


Scrotal calcinosis Scrotal calcinosis

Scrotal calcinosis

Scrotal calcinosis Scrotal calcinosis

Scrotal calcinosis

Cytology description
  • Cytological evaluation of scrotal calcinosis is usually not done due to its typical clinical appearance
  • Aspirate is difficult to obtain as it is thick and shows sticky, chalky white material
  • Smears reveal calcified, basophilic, amorphous, granular material along with refractile crystals
  • These features are nonspecific and raise a differential of calcified epidermal inclusion cysts, dystrophic calcification following any injury or inflammation and scrotal calcinosis (Diagn Cytopathol 2017;45:922)
Cytology images

Contributed by Sleiman Khal, M.D. (Case #468)

FNA smear of scrotal calcinosis



Images hosted on other servers:

FNA smear of scrotal calcinosis

Positive stains
  • Immunohistochemistry is not done in most cases since it is a straightforward histologic diagnosis
  • CK AE1 / AE3 may be utilized to highlight the presence of any component of epidermal inclusion cyst, seen in some cases (Dermatol Online J 2010;16:5)
Videos

Scrotal calcinosis: pathology mini tutorial

Sample pathology report
  • Scrotal mass, excision biopsy:
    • Scrotal calcinosis (see comment)
    • Comment: Scrotal calcinosis is a nonneoplastic condition. Localized excision is considered adequate treatment.
Differential diagnosis
  • Multiple epidermal inclusion cysts or pilar cysts in scrotum:
    • Some cases of scrotal calcinosis may have remnants of an epithelial cyst
    • True cysts are lined by stratified squamous epithelium
    • Lumen showing keratinous material
  • Idiopathic cutaneous calcinosis:
    • Usually in the extremities
    • Isolated scrotal involvement is rare
  • Dystrophic calcification due to Onchocerca volvulus:
    • Presence of parasite in tissue sections
Board review style question #1
Which of the following is true regarding scrotal calcinosis?

  1. Idiopathic in most cases
  2. More common in elderly
  3. Only affects Caucasians
  4. Related to hypercalcemia
  5. Usually a solitary lesion
Board review style answer #1
A. Idiopathic in most cases

Comment Here

Reference: Scrotal calcinosis
Board review style question #2

What is the most characteristic histological feature of scrotal calcinosis depicted in the photomicrograph shown above?

  1. Cyst formation
  2. Epidermal atrophy
  3. Granulomatous reaction
  4. Inflammation
  5. Multifocal deposits of calcium
Board review style answer #2
E. Multifocal deposits of calcium

Comment Here

Reference: Scrotal calcinosis
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