Tenosynovitis with Psammomatous Calcification: A Poorly Recognized Pseudotumor Related to Repetitive Tendinous Injury
W Shon, AL Folpe. Mayo Clinic, Rochester, MN
Background: The terms "idiopathic calcifying tenosynovitis" and "calcific tendinitis" are clinical and radiographic terms used to describe a syndrome of pain and tendinous calcification, most often involving the distal supraspinatus tendon of the shoulder region. The histopathological correlates of this clinico-radiographic syndrome were initially described in 1983 in a series of 2 cases by Gravanis and Gaffney, who coined the term "tenosynovitis with psammomatous calcification" to describe their morphologic findings. Subsequently only a very small number of similar cases have been reported, including some apparently included in a recent large series of mixed calcareous lesions of the distal extremities. For these reasons the morphological features of this entity remain poorly appreciated by pathologists, judging from our recent consultation experience.
Design: Five cases meeting criteria for tenosynovitis with psammomatous calcification were retrieved from our consultation and institutional archives. Clinical and follow-up information was obtained from the referring pathologists and our medical record system. All available hematoxylin and eosin-stained slides were reviewed.
Results: Cases involved the tendons and adjacent synovium of the distal extremities (2 feet, 1 carpal tendon, and 2 fingers) of women <20 (2 cases), 40 (1 case) and >60 92 cases) years of age. The lesions presented as a painful mass; a history of occupational or sports-related repetitive motion and/or persistent mild trauma was noted in all but one patients. No patient had a history of hyperphosphatemia. All lesions were treated by surgical excision and described clinically as variably cystic nodules composed of amorphous "cheese-like" debris. Histologically, the lesions were centered in the tendon and composed of a mixed (myo)fibroblastic and histiocytic proliferation in association with dystrophic calcification, including distinctive psammoma body-like spheroidal bodies.
Conclusions: The clinical and morphological characteristics of tenosynovitis with psammomatous calcification (distal location, absent hyperphosphatemia, psammatous calcifications) differ from those of typical idiopathic calcifying tenosynovitis/ calcific tenditinitis (proximal location, dystrophic tendinous calcification) and tumoral calcinosis (hyperphosphatemia, amorphous soft tissue calcification), and it should be recognized as a distinct clinicopathological entity. Improved recognition of these unique features by pathologists should allow ready diagnosis of this unusual pseudotumor in most instances.
Category: Bone & Soft Tissue
Monday, March 22, 2010 1:00 PM
Poster Session II # 18, Monday Afternoon