Scrotal calcinosis.

A 30-year-old man presented with multiple, painless nodular lesions on the scrotum that had gradually increased in size and number during the previous three years. There was no history of metabolic, systemic, neoplastic, or autoimmune disease. The patient stated that he had never experienced any scrotal disease (e.g., trauma, inflammation, infection). Physical examination revealed multiple, firm, painless, subcutaneous nodules within the scrotal wall that measured from 3 to 20 mm in diameter.[Figure 1] There were no areas of ulceration or discharge on the scrotal skin. Laboratory examinations, including serum calcium, phosphorus, and parathyroid hormone levels, showed no abnormality.

Figure 1

Multiple, firm, painless, subcutaneous nodules within the scrotal wall that measured from 3 to 20 mm in diameter

Histologic examination showed, under a normal epidermis, dermal nodules containing an amorphous and homogenous substance corresponding to calcium deposits. The nodules were surrounded by a fibrous capsule and no epithelial lining was noted. There was also a foreign body-type granulomatous reaction.

Idiopathic SC is a rare and benign condition first described by Lewinski in 1883. It appears mainly in men aged 20 to 40 years. Clinically, SC consists of hard, yellowish nodules within the dermis of scrotal skin. Nodules vary in size (from 1 mm to several centimeters) and number (solitary or multiple). The nodules are usually asymptomatic and patients seek medical advice mainly for cosmetic reasons. However, in some cases, there might be some heaviness, itching, or discharge from the calcified masses.

The pathogenesis of scrotal calcinosis is unclear and controversy exists as to whether the disease is idiopathic or the result of dystrophic calcification of preexisting structures, including epidermal cyst, eccrine epithelial cyst, and degenerated dartoic muscle.[123]

In our patient, there was no evidence of epidermoid or pilar cystic structure and there was no epithelial lining around the calcified lesions. According to the histologic findings, the case was considered idiopathic.

Although there is no consensus about the pathogenesis of this condition, the only treatment recommended is surgery.