title: A 23-year-old patient with secondary tumoral calcinosis: Regression after subtotal parathyroidectomy: A case report.
abstract: BACKGROUND
  Tumoral calcinosis (TC) is a rare disorder defined by hyperphosphatemia and ectopic calcifications in various locations. The most common form of TC is associated with disorders such as renal insufficiency, hyperparathyroidism, or hypervitaminosis D. The primary (hereditary) TC is caused by inactivating mutations in either the fibroblast growth factor 23 (FGF23), the GalNAc transferase 3 (GALNT3) or the KLOTHO (KL) gene.
  
  
  METHODS
  We report here a case of secondary TC in end-stage renal disease. The patient was on regular hemodialysis and presented with severe painful soft-tissue calcifications around her left hip and shoulder that had been increasing over the last two years. Initially, she was treated with dietary phosphate restriction and phosphate binders. Because of high phosphate blood levels, which were not yet managed with dialysis and medical therapy, a subtotal parathyroidectomy (sP) was performed. This approach demonstrated significant response. Three months after surgery a rapid regression of the tumors was observed.
  Regardless of the etiology, the two types of TC do not differ in their radiologic or histopathologic presentations but need to be diagnosed correctly to initiate targeted and effective treatment. Considering the primary TC, primary treatment is early and complete surgical excision. In case of secondary TC surgical excision of the tumoral masses should be avoid because of extensive complications. These patients benefit from sP.
  
  
  CONCLUSIONS
  After initial conservative therapy chronic kidney disease patients with TC might benefit from sP to avoid prolonged suffering and potential mutilations.
authors.affiliation: Department of General and Trauma Surgery, BG University Hospital, Bergmannsheil Bochum, Buerkle de la Camp-Platz 1, 44789 Bochum, Germany. Electronic address: katharina.niemann@bergmannsheil.de.
authors.forename: Katharina E
authors.initials: KE
authors.lastname: Niemann
authors.affiliation: Department of Surgery, Heinrich-Heine-University, University Hospital Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany. Electronic address: Feride.Kroepil@med.uni-duesseldorf.de.
authors.forename: Feride
authors.initials: F
authors.lastname: Kröpil
authors.affiliation: Department of General and Trauma Surgery, BG University Hospital, Bergmannsheil Bochum, Buerkle de la Camp-Platz 1, 44789 Bochum, Germany. Electronic address: martin.hoffmann@bergmannsheil.de.
authors.forename: Martin F
authors.initials: MF
authors.lastname: Hoffmann
authors.affiliation: Department of General and Trauma Surgery, BG University Hospital, Bergmannsheil Bochum, Buerkle de la Camp-Platz 1, 44789 Bochum, Germany. Electronic address: marlon_boston@yahoo.de.
authors.forename: Marlon O
authors.initials: MO
authors.lastname: Coulibaly
authors.affiliation: Department of General and Trauma Surgery, BG University Hospital, Bergmannsheil Bochum, Buerkle de la Camp-Platz 1, 44789 Bochum, Germany. Electronic address: thomas.a.schildhauer@ruhr-uni-bochum.de.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schildhauer
keywords: Case report; Chronic kidney disease; Parathyroidectomy; Teutschlaender disease; Tumoral calcinosis