Answer for BIR CoW 05 Apr 2026
Calcinosis cutis
Findings
Evidence of extensive, dense, amorphous and plaque like calcifications noted in the soft tissues around bilateral gluteal regions, lateral aspect of both hips, thighs and extending into the legs. - Features suggestive of calcinosis cutis.
Discussion
Calcinosis cutis is a rare condition characterized by the deposition of calcium compounds in the skin and subcutaneous tissues Etiological Subtypes: 1.Dystrophic (most common): characterised by normal serum calcium and phosphorus deposists, an underlying disease process induces tissue damage 2.Metastatic: abnormal serum calcium and phosphorus deposits. 3.Iatrogenic 4.Idiopathic Tumoral calcinosis - Juxta-articular calcified lumps in otherwise healthy youngsters Subepidermal calcified nodules - calcified nodules in a subepidermal location in the head, hands and feet, primarily in children It can be classified according to the pattern of distribution as: Calcinosis cutis circumscripta: Localised skin and subcutaneous calcifications predominantly around joints and extremity Calcinosis cutis universalis: Diffuse involvement of skin, subcutaneous tissues, muscles and tendons Differential diagnosis: 1.Tumoral calcinosis:Periarticular in location, bulky lobulated “cloud-like” masses with no true bone formation showing characteristic sedimentation sign (fluid–calcium levels caused by calcium layering within the cystic spaces of the lesion. ). 2.Myositis ossificans:Intramuscular lesion showing peripheral ossification with central immaturity and true bone formation present; classic zoning phenomenon showing ossification from peripheral to central zone 3.Phleboliths:Calcification within venous channels, typically round with a central lucency 4.Cysticercosis: Involves muscle/subcutaneous tissue with elongated “rice-grain” calcifications aligned along muscle fibers 5.Synovial sarcoma:Deep soft tissue mass near joints, appearing irregular and eccentric; may show osteoid formation, and on MRI demonstrates the triple sign - the markedly heterogeneous appearance of synovial cell sarcomas on fluid-sensitive sequences results in "triple sign" which is due to very high signal in areas of necrosis and cystic degeneration, relatively high signal soft tissue components and areas of low signal intensity due to dystrophic calcifications and fibrotic bands
References: Cuong Le, Paul M. Bedocs. Calcinosis Cutis. (2020) Pubmed Calcinosis Universalis. (1952) Radiology. 59 (3): 415-8. doi:10.1148/59.3.415 - Pubmed
Findings
Evidence of extensive, dense, amorphous and plaque like calcifications noted in the soft tissues around bilateral gluteal regions, lateral aspect of both hips, thighs and extending into the legs. - Features suggestive of calcinosis cutis.
Discussion
Calcinosis cutis is a rare condition characterized by the deposition of calcium compounds in the skin and subcutaneous tissues Etiological Subtypes: 1.Dystrophic (most common): characterised by normal serum calcium and phosphorus deposists, an underlying disease process induces tissue damage 2.Metastatic: abnormal serum calcium and phosphorus deposits. 3.Iatrogenic 4.Idiopathic Tumoral calcinosis - Juxta-articular calcified lumps in otherwise healthy youngsters Subepidermal calcified nodules - calcified nodules in a subepidermal location in the head, hands and feet, primarily in children It can be classified according to the pattern of distribution as: Calcinosis cutis circumscripta: Localised skin and subcutaneous calcifications predominantly around joints and extremity Calcinosis cutis universalis: Diffuse involvement of skin, subcutaneous tissues, muscles and tendons Differential diagnosis: 1.Tumoral calcinosis:Periarticular in location, bulky lobulated “cloud-like” masses with no true bone formation showing characteristic sedimentation sign (fluid–calcium levels caused by calcium layering within the cystic spaces of the lesion. ). 2.Myositis ossificans:Intramuscular lesion showing peripheral ossification with central immaturity and true bone formation present; classic zoning phenomenon showing ossification from peripheral to central zone 3.Phleboliths:Calcification within venous channels, typically round with a central lucency 4.Cysticercosis: Involves muscle/subcutaneous tissue with elongated “rice-grain” calcifications aligned along muscle fibers 5.Synovial sarcoma:Deep soft tissue mass near joints, appearing irregular and eccentric; may show osteoid formation, and on MRI demonstrates the triple sign - the markedly heterogeneous appearance of synovial cell sarcomas on fluid-sensitive sequences results in "triple sign" which is due to very high signal in areas of necrosis and cystic degeneration, relatively high signal soft tissue components and areas of low signal intensity due to dystrophic calcifications and fibrotic bands
References: Cuong Le, Paul M. Bedocs. Calcinosis Cutis. (2020) Pubmed Calcinosis Universalis. (1952) Radiology. 59 (3): 415-8. doi:10.1148/59.3.415 - Pubmed
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!