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Scrotal calcinosis: two case reports
© The Author(s). 2017
Received: 10 August 2017
Accepted: 12 September 2017
Published: 5 November 2017
Scrotal calcinosis is a rare and benign condition. It usually gives rise to few symptoms, and the impact is mainly functional and aesthetic. It is considered part of dystrophic calcinosis cutis. Surgical management is the only curative approach, and recurrence has been described in few cases.
We report cases of two North African white patients with operated scrotal calcinosis. We describe the clinical and histological aspects as well as a pathogenic hypothesis and surgical management principles.
A surgical approach to scrotal calcinosis must consider the aesthetic and functional aspects postoperatively. A complete excision prevents recurrence. Psychological support is required in association with surgery because the lesions are benign and concern an intimate part of the body.
Scrotal calcinosis is described as a skin condition of multiple hard, painless, asymptomatic cutaneous nodules without abnormalities in the phosphocalcic metabolism. It usually occurs in young adults with no histology of traumatism, genitourinary infections, or hormonal disorders. Diagnostic certitude is based on histology of the surgical resection specimen. Surgical resection should be as complete as possible, involving small nodular lesions, in order to rule out recurrence. The prognosis is favorable because, to our knowledge, malignant degeneration has not been described to date.
The patient was examined in the outpatient clinic at 3 weeks and 2 months after surgery. The aesthetic result was judged satisfying, with sexual improvement reported by the patient.
Scrotal calcinosis is a benign condition first described by Lewinski over a century ago . It is reported to be more frequent in black patients between the second and fourth decades of life. Some cases have occurred in infants and in elderly patients . A delay between the beginning of symptoms and the first consultation is usually noted because the lesions affect an intimate part of the body.
Lesions are nodular and indolent, without any discharge or inflammatory and bilateral signs. A penile location has been reported for multiple scrotal calcinosis nodules causing sexual discomfort . To our knowledge, only one case of a unilateral form has been published in the English literature . Lesion size ranges from a few millimeters to several centimeters .
The question about the etiopathogenesis is not resolved. As scrotal calcinosis is not associated to any metabolic or hormonal disorder, mainly the calcium and the phosphorus metabolism and the parathyroid hormone activity, the idiopathic character was previously approved . Song et al., analyzing more than 50 nodules of scrotal calcinosis, concluded that the common characteristic is a calcified dystrophy of epidermal cysts . This theory was widely recognized after the histological and biochemical evaluation of 100 cases of scrotal calcinosis by Dubey et al. . Other authors supported the calcified dystrophy of the dartoic muscle , but this theory is less convincing than that of Dubey et al. Histological examination using Von Kossa staining usually reveals a basophilic, calcified deposit in the scrotal dermis and the calcinosis nodules that is surrounded by giant cell granulomas in an intense foreign body inflammatory reaction .
Surgery is usually performed in patients presenting with voluminous lesions carrying a psychological and a sexual prejudice. The total excision of calcified nodules may ignore small lesions, and there is potential for recurrence . Recently, Noel et al.  proposed a one-stage technique used mainly for giant nodules with a considerable skin defect. Elliptic resection is performed after making an incision centered on the median raphe and a thorough dissection of the scrotal dermis from the dartoic muscle, allowing more pertinent detection of small nodules than the classical resection of nodules detectable on the surface of the skin. This technique is a particularly attractive procedure because the vascularization provided by the external pudendal artery is peripheral . The aesthetic result is better after a median raphe incision and a fine dissection conserving the integrity of the skin integumentary capillaries.
The prognosis after surgery is favorable. Few cases of recurrence have been reported. Recurrence seems to be related to neglected millimetric nodules that increase in size later [5, 12]. No cases of malignant transformation have been reported .
Scrotal calcinosis is a benign condition that occurs in young adults. Clinicians have to reassure patients because the nodules concern an intimate part of the body. Urologists have to keep in mind the aesthetic prejudice and the functional aspect of the surgery. An acceptable restitution of the scrotal skin integument after surgical excision is imperative. Better knowledge of the etiopathogenic aspects of scrotal calcinosis may lead to more efficient surgical procedures with the aim of ensuring better results and preventing recurrences.
No funding was secured for this study.
Availability of data and materials
The authors will make readily reproducible and freely available materials described in this report to any scientist wishing to use them, without breaching the patient confidentiality. The authors will make materials described in this report available for testing by reviewers in a way that preserves the reviewers’ anonymity.
OK and HK performed the surgery and conceived of and designed the study. OK, AD, RB and KB were responsible for the acquisition of data. RB and AD performed the analysis and interpretation of data. HK and KB gave final approval of the manuscript to be published. All authors read and approved the final manuscript.
Ethics approval and consent to participate
No ethics committee approval was required at our institution for this case report involving a limited number of patients.
Consent for publication
Written informed consent was obtained from the patients for publication of this case report and any accompanying images. A copy of the written consents are available for review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
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