ULTRASOUND IMAGING AND PATHOLOGIC FEATURES OF IDIOPATHIC SCROTAL CALCINOSIS IN A YOUNG ADULT NIGERIAN AND REVIEW OF THE LITERATURE

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S.J. Ayilara¹, O.I. Lawrence¹, T.E. Ogunsanya², E.O. Fatunla², A.M. Agunloye¹, G.I. Ogbole¹

1. Department of Radiology, University College Hospital, Ibadan, Nigeria.
2. Department of Pathology, University College Hospital, Ibadan, Nigeria.

Abstract

Background: Idiopathic scrotal calcinosis is a rare and benign disease of the scrotal skin that presents as solitary or multiple painless calcified nodules or papules in the absence of systemic disorders of calcium or phosphorus metabolism. Although some theories have been proposed as to the cause of this rare disease, the exact cause remains unknown. In a resource-poor medical setting like Nigeria, a confident diagnosis of this condition can be made with ultrasonography.

Objective: The objective of this report is to emphasize the role of ultrasound in the imaging diagnosis of idiopathic scrotal calcinosis.

Case Presentation: This is a case report of a 38-year-old man who presented with recently discharging but longstanding multiple painless scrotal nodules of 22-years duration.

Conclusion: This case illustrates the prompt and accurate diagnosis of idiopathic scrotal calcinosis using an ultrasound, a readily available imaging modality in a low-resource setting. Although histology remains the gold-standard for diagnosing idiopathic scrotal calcinosis following surgical excision, this benign disorder has unique sonographic characteristics that could aid the radiologist in making a confident diagnosis.

Keywords: Idiopathic scrotal calcinosis, Calcification, Ultrasound, Computed tomography, Magnetic resonance imaging.

Introduction

Idiopathic scrotal calcinosis (ISC), sometimes called dystrophic scrotal calcinosis, is a rare benign disease of the scrotal skin that presents with solitary or multiple, painless calcified nodules or papules of varying sizes on the scrotal wall. ^1,2 Although, few cases have been reported in infants and the elderly,^1,3,4 this condition usually presents in early adulthood in the absence of systemic disorder of the calcium or phosphorus metabolism.

Historically, this condition was first reported by Lewinski in 1883² and about a century afterwards Shapiro named it as ‘idiopathic scrotal calcinosis’.¹ Several theories have been proposed as to the cause of ISC; Shapiro et al ⁵ suggested that it could be idiopathic while Karabulut et al⁶ proposed dystrophic calcification following calcium deposition on epidermal cysts. However, the exact cause and nature of ISC have remained elusive.^2,4 Although histology remains the gold standard of diagnostic confirmation⁷ after surgical excision,¹ the diagnosis of ISC can be confidently made radiologically.

This is a case of ISC seen in our institution. The summary of sonographic findings is presented, and we reviewed the literature.