Published online Mar 18, 2024. doi: 10.5312/wjo.v15.i3.302
Peer-review started: December 3, 2023
First decision: December 28, 2023
Revised: January 6, 2024
Accepted: January 24, 2024
Article in press: January 24, 2024
Published online: March 18, 2024
Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues, occurring in hemodialysis patients. Calcium phosphate crystals are mainly composed of hydroxyapatite, which is highly infiltrative to tissues, thus making complete resection difficult. An adjuvant method to remove or resolve the residual crystals during the operation is necessary.
A bicarbonate Ringer’s solution with bicarbonate ions (28 mEq/L) was used as the adjuvant. After resecting calcium phosphate deposits of tumoral calcinosis as much as possible, while filling with the solution, residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field. A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders, bilateral hip joints, and the right foot. A shoulder lesion was resected, but the calcification remained and early re-deposition was observed. Considering the difficulty of a complete rection, we devised a bicarbonate dissolution method and excised the foot lesion. After resection of the calcified material, the residual calcified material was washed away with bicarbonate Ringer’s solution.
The bicarbonate dissolution method is a new, simple, and effective treatment for tumoral calcinosis in hemodialysis patients.
Core Tip: Tumoral calcinosis, which occurs in 2%-3% of hemodialysis patients, involves calcium phosphate deposits, thus making surgical resection challenging. Hydroxyapatite, the main component of tumoral calcinosis, infiltrates tissues extensively. A bicarbonate Ringer’s solution is used post-resection. A 49-year-old hemodialysis patient with calcified shoulder, hip, and foot lesions underwent the bicarbonate dissolution method. After resection, the operative field was washed with the solution. This simple and effective treatment offers a novel approach for managing tumoral calcinosis in hemodialysis patients.