Idiopathic scrotal calcinosis: Cytodiagnosis of a rare case

Swati Singh; Mayurika S Tyagi; Malay Bajpai; Prem Garg; Abhishek Pathre

doi:10.4103/2455-1732.331790

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CASE REPORT

Year : 2021 | Volume : 7 | Issue : 2 | Page : 56-58

Idiopathic scrotal calcinosis: Cytodiagnosis of a rare case

Swati Singh, Mayurika S Tyagi, Malay Bajpai, Prem Garg, Abhishek Pathre
Department of Pathology, Santosh Medical College, Santosh Deemed to be University, Ghaziabad, Uttar Pradesh, India

Date of Web Publication

6-Dec-2021

Correspondence Address:
Mayurika S Tyagi
Department of Pathology, Santosh Medical College, Santosh Deemed to be University, Ghaziabad, Uttar Pradesh
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2455-1732.331790

Abstract

A 38-year-old male presented with multiple, painless, tense, soft-to-firm nodules within the scrotal skin for the past 5 years with a provisional clinical diagnosis of a sebaceous cyst of the scrotum. Fine-needle aspiration cytology (FNAC) was performed from the scrotal lesions. Fine-needle aspiration smears showed amorphous, basophilic, calcified material without any epithelial cells. Hence, a diagnosis of idiopathic calcinosis of the scrotum was suggested. Histopathological examination of the resected specimen reaffirmed the diagnosis. We report this case highlighting the role of FNAC as a tool for preoperative diagnosis of idiopathic scrotal calcinosis.

Keywords: Fine-needle aspiration cytology, idiopathic calcinosis, scrotum

How to cite this article:
Singh S, Tyagi MS, Bajpai M, Garg P, Pathre A. Idiopathic scrotal calcinosis: Cytodiagnosis of a rare case. Santosh Univ J Health Sci 2021;7:56-8

How to cite this URL:
Singh S, Tyagi MS, Bajpai M, Garg P, Pathre A. Idiopathic scrotal calcinosis: Cytodiagnosis of a rare case. Santosh Univ J Health Sci [serial online] 2021 [cited 2023 May 30];7:56-8. Available from: http://www.sujhs.org/text.asp?2021/7/2/56/331790

Introduction

Idiopathic calcinosis of the scrotum is a benign and rare lesion characterized by multiple asymptomatic and calcified nodules within the scrotal skin without any anomaly of calcium or phosphorus metabolism.

The nodules usually appear during childhood or early adulthood and may vary in size and number. Histopathologically, scrotal calcinosis shows deposits of calcium and phosphates within the dermis.^[1]

Cytology also can be utilized as a diagnostic tool in such cases. However, there are very few case reports in this regard. Aspiration cytology has an added advantage in that it helps in early and preoperative diagnosis. We report a case of clinically unsuspected case in a 38-year-old patient. The initial clinical suspicion being an epidermal inclusion cyst in the case.

Case Report

A 38-year-old male presented in the outpatient clinic with multiple, painless, tense, soft-to-firm nodules within the scrotal skin for the past 5 years. There was no prior history of trauma, inflammation, or any other scrotal disease. Local scrotal examination revealed multiple small nodular swellings ranging in size from 0.5 cm to 2 cm in diameter. On clinical examination, the external genitalia and groin did not reveal any other abnormality. Serum and urinary levels of phosphate and calcium were normal. A provisional clinical diagnosis of sebaceous cysts of the scrotum was made, and a fine-needle aspiration cytology of the lesion was planned.

Fine-needle aspiration of nodules was performed using a 21 mm gauge needle. Alcohol fixed wet smears, and air-dried smears were made. Alcohol-fixed smears were stained with Giemsa stain. Fine-needle aspiration (FNA) smears showed predominantly amorphous, basophilic masses and granules of calcium on a background of calcium debris [Figure 1]. The findings were confirmed by von Kossa stain for calcium. No epithelial cells were seen in the smears examined. Hence, on aspiration cytology, a cytological diagnosis of idiopathic calcinosis of the scrotum was made.

Figure 1: Smear shows amorphous basophilic material suggestive of calcification in aspiration cytology (Giemsa stain; ×400)

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Due to the discordance between the clinical and cytological diagnosis, surgical excision was performed for confirmation. Histopathological examination also showed amorphous, basophilic deposits of calcium in the dermis with focal inflammation in the background [Figure 2]. No cellular lining epithelium was noted. The diagnosis of idiopathic calcinosis of the scrotum was confirmed on histopathology.

Figure 2: HPE section shows the overlying epidermis with amorphous calcified deposits in the dermis without epithelial lining (H and E, ×400)

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Discussion

Idiopathic scrotal calcinosis, first described by H.M. Lewinsky in 1883,^[2] is a benign, rare subtype of calcinosis cutis characterized by calcium deposition in the form of multiple nodular hard swellings over the scrotum. It commonly occurs in the 20–40 years of age group.

The pathogenesis of idiopathic scrotal calcinosis remains unclear, and numerous theories have been proposed.^[3] Controversy concerning the origin of idiopathic scrotal calcinosis remains, whether the nodules result from dystrophic calcification of preexistent epidermal inclusion cysts or if they have emerged de novo without any triggering metabolic condition. Shapiro et al.^[4] proposed the condition's idiopathic nature after histopathologic evaluation of 14 cases with Idiopathic scrotal calcinosis that demonstrated no cyst wall structure. Other studies have subsequently supported this hypothesis.^[5],[6] The fine needle aspiration technique is a simple, rapid outpatient procedure and does not require sophisticated instruments. Cytological diagnosis shows concordance in most of the lesions and can be used routinely as an adjunct to histopathology and can be done as a preoperative outpatient procedure.

The first case of idiopathic calcinosis of the scrotum on fine-needle aspiration cytology was reported by Shivkumar et al.^[7] Subsequently, Sherwani et al.^[8] and Dombale et al.^[9] also described cytological features of scrotal calcinosis. The absence of epithelial cells in the FNA smears helps differentiate idiopathic scrotal calcinosis from a calcified epidermal cyst. The cytomorphological findings depicted in these case reports were identical to our case and corroborated well with the histopathological features.

Conclusion

This case report highlights the significant role of cytology in the quick diagnosis of the rare entity of idiopathic scrotal calcinosis. The simplicity, cost-effectiveness, and rapid, reliable results are the further criteria promoting it to be a better option when compared with other techniques.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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