Fictitious calculi and human calculi with foreign nuclei.

The correlative approach employing polarized light microscopy, x-ray powder diffraction, scanning electron microscopy, transmission electron microscopy, selected area electron diffraction and energy dispersive x-ray microanalysis proves to be very useful in identifying fictitious calculi and genuine human calculi with foreign body nuclei. The common artifacts as reported in the literature and observed also by us were minerals, vegetable and plant seeds, cereals, sand grains and sea shell fragments. Two interesting cases involving foreign body nuclei have been reported: one urinary calculus containing a piece of plastic-coated titanium foil in the center; one nasal calculus with a nut as a nucleus. Another common cause for foreign body nucleation is iatrogenic: intrauterine devices, catheters, suture materials and even surgical staples have been reported in the literature to be potent nidi for calculus formation. These cases remind us of the important fact that our body fluids are supersaturated with respect to calcium phosphates and occasionally to other compounds. Hydroxyapatite crystals are readily nucleated by foreign bodies. Whitlockite is involved if the fluid Mg/Ca ratio is in a suitable range, brushite if the fluid is acidic and struvite if there is urea-splitting infection. In urine and other fluids, calcium oxalate and uric acid crystals contribute to the calculus growth.