Unusual radiographic progression of tumoral calcinosis along the anterior cruciate ligament in an adolescent male

Adiba Perkins; Kurren Desai; Bradley Trotter; Russell Ward; Gregory Sprowls; Riyam Zreik; Colleen Macmurdo; Lorelai Tariske; Krista Birkemeier

doi:10.1080/08998280.2024.2403938

Unusual radiographic progression of tumoral calcinosis along the anterior cruciate ligament in an adolescent male

Proc (Bayl Univ Med Cent). 2024 Sep 30;38(1):85-90. doi: 10.1080/08998280.2024.2403938. eCollection 2025.

Authors

Adiba Perkins^{1

2}, Kurren Desai^{1

2}, Bradley Trotter^{1

2}, Russell Ward^{1

3}, Gregory Sprowls^{1

3}, Riyam Zreik^{1

4}, Colleen Macmurdo^{1

5}, Lorelai Tariske⁶, Krista Birkemeier^{1

2}

Affiliations

¹ Texas A&M University, Temple, Texas, USA.
² Department of Radiology, Baylor Scott & White McLane Children's Medical Center, Temple, Texas, USA.
³ Department of Orthopedic Surgery, Baylor Scott & White McLane Children's Medical Center, Temple, Texas, USA.
⁴ Department of Pathology, Baylor Scott & White McLane Children's Medical Center, Temple, Texas, USA.
⁵ Department of Genetics, Baylor Scott & White McLane Children's Medical Center, Temple, Texas, USA.
⁶ Baylor Scott & White Research Institute, Temple, Texas, USA.

Abstract

A 13-year-old boy was referred to orthopedic surgery for chronic intermittent pain and swelling of the left knee. Initial imaging was consistent with osteochondritis dissecans of the femoral condyle. Follow-up imaging demonstrated unexpected progression, with a mass extending into the notch, replacing the anterior cruciate ligament, and eroding the femoral and tibial condyles. Subsequent surgical biopsy and resection revealed tumoral calcinosis, with an ultimate diagnosis of autosomal recessive familial tumoral calcinosis. This case report highlights the radiographic appearance and progression of a rare disease in this unusual location and the differential diagnosis.

Keywords: Adolescent; MRI; anterior cruciate ligament; knee; pediatric; tumoral calcinosis.

Plain language summary

Tumoral calcinosis (TC) is a rare disease that typically presents in the periarticular soft tissues along extensor surfaces of large joints in adolescents and young adults, with greater frequency in African-descent populations.¹ ^, ²TC may cause pain, swelling, and loss of range of motion of the nearby joint.¹On imaging, TC is typically superficial with calcified lobular masses, layering milk of calcium and/or hemorrhage in cysts on magnetic resonance imaging, and only septal enhancement. Atypical features include bone involvement, intra-articular/extrasynovial joint space involvement, and lack of cysts.¹ ^, ^3–5Hyperphosphatemic TC, normophosphatemic TC, and secondary causes can usually be discerned with history and biochemical analysis (serum calcium, phosphorus, calcitriol, parathyroid hormone, and renal function tests). If the serum calcium and phosphorus are normal, connective tissue disease should be excluded with a negative antinuclear, anti-Smith, anti-centromere, and anti-scleroderma antibody profile.¹ ^, ⁶.

Publication types

Case Reports