title: Dystrophic calcinosis with both a huge calcified mass in the cervical spine and calcification in the chest wall in a patient with rheumatoid overlap syndrome.
abstract: Dystrophic calcinosis in soft tissue occurs in damaged or devitalized tissues in the presence of normal calcium and phosphorous metabolism. It is often noted in subcutaneous tissues in patients with collagen vascular diseases and may involve a relatively localized area or be widespread. A 74-year-old Japanese woman with an overlap of rheumatoid arthritis, Sjögren's syndrome, and systemic sclerosis developed a huge tumor-like mass at the atlanto-axial vertebral joint region that caused severe cervical pain and difficulty in activities of daily living. She also had subcutaneous dystrophic calcification in the soft tissue of the chest wall. Calcinosis associated with systemic sclerosis is a well-recognized phenomenon, but a destructive paraspinal tumor in the cervical spine associated with overlap syndrome is extremely unique. Because calcinosis in spinal locations can be complicated by neurological involvement, patients with progressive symptoms may require surgical intervention. Surgical resection and biological therapy improved this patient's life and activities of daily living. Calcinosis is common in the conditions reviewed here, and different agents have been used for treatment. However, calcinosis management is poorly organized and lacks an accepted classification, systematic studies, and clinical therapeutic trials. The association of calcinosis and collagen vascular diseases is clinically and etiologically important. Although a combination of calcinosis and rheumatoid overlap syndrome is rare, various collagen vascular diseases may occur simultaneously. A perceptive diagnostic approach toward these diseases is critical, and early diagnosis and treatment are needed to prevent dystrophic calcinosis.
authors.affiliation: Section of Clinical Rheumatology, Kumamoto Shinto General Hospital, 1-17-27 Shinyashiki, Chuo-ku, Kumamoto, 862-8655, Japan. nakamura@k-shinto.or.jp.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Section of Orthodeadic Surgery, Kumamoto Orthopaedic Hospital, Kumamoto, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Hirakawa
authors.affiliation: Section of Clinical Rheumatology, Kumamoto Shinto General Hospital, 1-17-27 Shinyashiki, Chuo-ku, Kumamoto, 862-8655, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Takaoka
authors.affiliation: Department of Surgical Pathology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Iyama
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D002574:Cervical Vertebrae / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D012595:Scleroderma, Systemic / Q000150:complications* / Q000000981:diagnostic imaging; D012859:Sjogren's Syndrome / Q000150:complications* / Q000000981:diagnostic imaging; D035441:Thoracic Wall / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Collagen vascular diseases; Dystrophic calcinosis; Rheumatoid arthritis; Rheumatoid overlap syndrome; Sjögren’s syndrome; Systemic sclerosis