Calcinosis cutis is an abnormality of calcium deposits within the dermis layer. Idiopathic scrotal calcinosis (IKS) is a very rare benign tumor, characterized by the presence of several asymptomatic nodules in the scrotal skin layer without abnormalities in calcium or phosphorus metabolism. This disease is benign but apparently has a major impact on the quality of life of sufferers. IKS was first defined by Lewinski in 1883. The cause of this disease is not yet known with certainty, the underlying mechanism is still controversial today.
IKS often appears in the third and fourth decades of life. The condition can develop for several years before the patient consults a doctor because it is in “intimate” area and asymptomatic. Clinical manifestations are very typical of white hard rock nodules on the scrotal skin. In majority of cases, they are asymptomatic, patients often seek treatment due to cosmetic reasons or the itching and secondary infections.
The diagnosis of IKS is from histopathological examination in the form of depictions of calcium deposits with varying sizes in the dermis layer surrounded by histiocytic and giant inflammatory cells. The recommended treatment is elliptical excision surgery on the nodules above the dartos muscle fascia, because the nodules are located in the dermis layer.
Indonesian man aged 45 years, with multiple nodules of various sizes was identified. Lesions have gradually increased in size over the past 2 decades without causing symptoms or discomfort. Complete laboratory blood tests show a picture in the normal range, serum calcium and urine and phosphorus in the normal range, levels of parathyroid hormone in the normal limit, vitamin D 25 (OH) in the normal limit, and blood sugar in the normal range. Histopathological examination revealed extensive intradermal deposition of calcium surrounded by histiocytes and without cystic structures. Surgical excision of the nodules from the scrotal skin has been carried out without causing complications. And there have not been any recurrences during the past six months.
IKS is the most common form of idiopathic calcinosis cutis. Some theories about the cause of this disease have been put forward and the evidence showed that this disease is a series of unified process. Patients are slow to consult because of the predilection of this disease in the “intimate” areas of the body. Surgery is a therapeutic choice for idiopathic calcinosis cutis. Simple and effective surgery has helped to grow patient confidence. Although recurrence after surgery is rare, patients need to have follow up exams.
Author: Dwi Murtiastutik, dr.Sp.KK (K)
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Idiopathic scrotal calcinosis: Rare case
Putri Intan Primasari, Septiana Widyantari, Dwi Murtiatutik