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The possible role of dartoic muscle degeneration in the pathogenesis of idiopathic scrotal calcinosis

2003; Oxford University Press; Volume: 148; Issue: 4 Linguagem: Inglês

10.1046/j.1365-2133.2003.05251.x

1365-2133

Uğur Pabuçcuoğlu, mehmet şerafettin canda, Merih Güray, A. Kéfi, Erdem Canda,

Skin Diseases and Diabetes

Sir, We report an otherwise healthy 63‐year‐old man with no systemic metabolic disorders, who presented with multiple slowly growing scrotal nodules that had been present since his childhood. There was a recurrent discharge of chalky material from these nodules. Serum calcium and phosphate levels were within normal ranges. The involved scrotal skin was completely excised. Healing was uneventful. The specimen received for pathological examination consisted of eight pieces of polypoid tissues covered with skin, with the largest being 4 × 3·5 × 2·5 cm in size. Cut sections of the tissues revealed multiple firm nodules, some of which were heavily calcified. Microscopic examination showed multiple cystic or duct‐like spaces with an amorphous, periodic acid–Schiff (PAS)‐positive and von Kossa‐negative central content along with prominent nodules of partially calcified PAS‐positive amorphous material in the dermis (Fig. 1a). Nodules were surrounded by fibrous tissue and a foreign body giant cell reaction was focally present in the vicinity of the calcified material. No keratinous material was observed in the histological slides. Immunohistochemistry for carcinoembryonic antigen and cytokeratin failed to show any positive reaction (epithelial lining) either in the duct‐like spaces or around the calcified nodules. A thorough histological examination revealed degenerative changes in the dartoic muscle bundles, with a gradual transition to necrotic forms, which also corresponded to the central amorphous substance in the dilated duct‐like spaces. Gomori's reticulin stain revealed the presence of collapsed reticular fibres within the central substance (Fig. 1b). The silhouette of the necrotic bundles was morphologically comparable with the vital dartoic muscle fibres. Smooth muscle actin was intensely positive in dartoic muscle and showed faint or no staining in the degenerated and necrotic muscle bundles. The histopathological diagnosis was that of idiopathic scrotal calcinosis.