PMC4691467_01
External appearance of the right wrist joint.
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On physical examination, the radial nodular lesion was 2 cm x 2 cm in size, the dorsal nodular lesion was 2 cm x 2.5 cm in size, and these nodular lesions were not movable, painful, or tender (Figure 1).
X-ray findings show some calcified nodular lesions on the right wrist joint.
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Radiographs of the right wrist joint before surgery showed multiple periarticular nodular lesions with calcifications on the volar (this lesion was not palpable on the skin), radial, and dorsal aspects of the right wrist joint (Figure 2).
Computed tomography shows the details of the lesions.
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On computed tomography (CT), multiple calcified nodular lesions in and around the right wrist joint were shown in detail (Figure 3).
Magnetic resonance imaging reveals some nodular lesions at the wrist joint. (a) T2-weighted imaging. (b) T1-weighted imaging.
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Magnetic resonance imaging (MRI) revealed that these nodular lesions around the right wrist joint showed low signal intensity on T1-weighted images and a mixture of high- and isosignal intensity on T2-weighted images (Figure 4).
Photographs show nodular lesions of the resected specimen. (a) Volar lesions were resected piece by piece. (b) Radial lesion. (c) Dorsal lesions were resected en bloc.
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First, the volar lesion was excised piece by piece, avoiding the flexor tendons and the median nerve (Figure 5(a)). Next, the lesion was excised en bloc (Figure 5(b)). The lesion on the dorsal side was excised en bloc via a dorsal incision avoiding the extensor tendons and opening the 4th extensor compartment (Figure 5(c)).
Photomicrograph of the tumoral mass shows deposits of crystals surrounded by fibroblasts, macrophages, and foreign body-type giant cells (H&E, (a) low-power view, (b) high-power view). Under polarized light, the calcified deposits show weekly positive birefringence suggestive of CPPD ((c) low-power view, (d) high-power view).
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On histological examination of the excised tumor tissue with H&E staining, numerous polarizable, rhabdoid, and rectangular crystals, surrounded by fibroblasts, macrophages, and foreign body-type giant cells, were seen (Figures 6(a) and 6(b)). The calcified deposits showed weakly positive birefringent polarized light, suggestive of CPPD crystals, and these findings were consistent with tumoral CPPDCD (Figures 6(c) and 6(d)).
X-ray findings at last follow-up, 6 months after surgery.
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