Scrotal Calcinosis: A Case Report and Review of Pathogenesis and Surgical Management

Idiopathic scrotal calcinosis is an uncommon benign disorder of the scrotal skin which is characterized by multiple calcified intradermal nodules. We report a 33-year old with asymptomatic multiple calcified scrotal skin nodules. He had wide excision of the lesions and direct closure of the scrotum. We review the pathogenesis and surgical treatment options for this rare disease of the scrotum. 1. Introduction Idiopathic scrotal calcinosis is an uncommon benign disorder of the scrotal skin characterized by multiple calcified intradermal nodules that occur in the presence of normal calcium and phosphate metabolism. This disease was first described by Lewinsky as a subtype of calcinosis cutis [1]. The pathogenesis of scrotal calcinosis is still controversial. Our aim is to report this disease in a 33-year-old man and review the pathogenesis and surgical management. 2. Case Presentation A 33-year-old man presented to us with rashes on the scrotum of 2 years duration. The rashes have been painless, gradually increasing in size and number to the current state. There was no preceding history suggestive of sexually transmitted disease (STD), trauma, inflammation to the scrotum. He is not a known diabetic, and not on any immunosuppressive drugs. There are no features suggestive of hypercalcaemia. On physical examination, he was fit looking with Athletic physique. Review of systems was normal. The main finding was on scrotal examination, which revealed multiple nodular lesions involving the ventral surface of the scrotum, sparing other part of the scrotum and the penis. The largest nodule measured about 6？mm by 5？mm (Figure 1). The lesions were not ulcerated or tender. Scrotal X-ray revealed multiple opacities in area of the lesions (Figure 2). Serum calcium, phosphate and albumin were within reference value. Diabetes and retroviral screening were negative. Figure 1: Multinodular lesions of scrotal skin. Figure 2: X-ray showing calcific scrotal nodules. Histology of the incisional biopsy showed calcium deposits in the dermis of scrotum surrounded by pseudocapsule and histiocytic inflammation. No evidence of cyst wall or keratin. He requested for excision on cosmetic ground. Wide local excision of lesion with direct closure was done with good postoperative outcome. The intraoperative and postoperative findings were shown in Figures 3, 4, and 5. Histology of the excised lesion remained the same. He was seen 16 months postoperatively, with no evidence of recurrence. Figure 3: Excision of scrotal calcinosis. Figure 4: Postexcision scrotal calcinosis spacemen. Figure