Idiopathic scrotal calcinosis is a

cutaneous Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different d ...

condition characterized by calcification of the skin resulting from the deposition of calcium and phosphorus occurring on the

scrotum The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum co ...

. However, the levels of calcium and phosphate in the blood are normal. Idiopathic scrotal calcinosis typically affects young males, with an onset between adolescence and early adulthood. The scrotal calcinosis appears, without any symptoms, as yellowish nodules that range in size from 1 mm to several centimeters. Without known links to other lesions or systemic pre-conditions, scrotal calcinosis was considered idiopathic. It is not related to calcium phosphate imbalance or renal insufficiency. By 2010, studies supported that epidermoid cysts are believed to be caused by

dystrophic calcification Dystrophic calcification (DC) is the calcification occurring in degenerated or necrotic tissue, as in hyalinized scars, degenerated foci in leiomyomas, and caseous nodules. This occurs as a reaction to tissue damage, including as a consequence ...

. This process involves subclinical inflammation, rupture, calcification, and cyst wall obliteration.

Presentation

* Single or multiple hard, marble-like nodules of varying size affecting scrotal skin. * Nodules vary in size from a few millimeters to a few centimeters. * Usually start to appear in childhood or early adult life * Over time, nodules increase in number and size * Nodules may break down and discharge chalky material * Rarely, lesions may be polypoid * Usually asymptomatic

Etiology

The cause is not well defined. Originally considered

idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin. From Greek ἴδιος ''idios'' "one's own" and πάθος ''pathos'' "suffering", ''idiopathy'' means approximately "a disease of its own kin ...

condition. Now accepted that majority of cases develop from dystrophic calcification of cyst contents.

Diagnostic

* Clinically Relevant Pathologic Features * Lesions slowly progress throughout life ** They slowly increase in number and size * Nodules are mobile and do not attach to underlying structures Pathologic Interpretation Pearls * Globular and granular purple deposits within dermis surrounded by giant cell granulomatous reaction * Sometimes remnants of cystic lesion can be identified * Very distinctive appearance with almost no histologic differential diagnosis.

Treatment

Treatment may involve surgery, which is currently the only recommended intervention. Surgery should include the removal of even small nodules, to prevent the recurrence of the scrotal calcinosis.

Prognosis

* Benign condition * Slow progression throughout life * Lesions remain discrete and do not become confluent

Epidemiology

* Incidence: uncommon * Age: children and young adults

History

Scrotal calcinosis was first described in 1883 by Lewinski.

References

{{reflist Skin conditions resulting from errors in metabolism Scrotum