Calcinosis cutis at a rare site: A Case Report
DOI:
https://doi.org/10.51168/h29wfs31Keywords:
Calcinosis cutis, Fine needle aspiration cytology, Idiopathic calcinosis, Malleolus, Subcutaneous calcification, HistopathologyAbstract
Background:
Calcinosis cutis is characterized by deposition of insoluble calcium salts, including hydroxyapatite and calcium phosphate, within the skin and subcutaneous tissue. It may be dystrophic, metastatic, iatrogenic, or idiopathic. Involvement of the malleolar region is uncommon and may clinically simulate a calcified soft-tissue or bony lesion. This case report aims to highlight the diagnostic value of clinicoradiological, cytological, and histopathological correlation in an unusual presentation of calcinosis cutis.
Case presentation:
A 49-year-old male presented with a hard, non-tender, non-mobile swelling measuring approximately 2 × 2 cm over the right lateral malleolus for 10 years. There was no history of pain or discharge. Hematological and biochemical investigations, including complete blood count, serum calcium, and phosphorus, were within normal limits. Radiography showed a lobulated bony outgrowth projecting from the right lateral malleolus. Fine needle aspiration yielded chalky white material. Cytology demonstrated mononuclear cells, multinucleated giant cells, multiple calcifications, and phosphate crystals in a ferning pattern. Surgical excision showed a skin-covered specimen measuring 3 × 2 × 1.5 cm with yellow and grey-white gritty areas. Histopathology revealed stratified squamous epithelium with underlying nodular deposits of basophilic amorphous calcification in fibrous connective tissue, confirming calcinosis cutis.
Take-away lessons: Long-standing, firm subcutaneous swellings at uncommon sites should not be presumed to be bony or cartilaginous lesions. Chalky white aspirate on fine needle aspiration is an important diagnostic clue. Normal serum calcium and phosphorus levels support an idiopathic form after exclusion of systemic, traumatic, and iatrogenic causes.
Conclusion:
Calcinosis cutis should be considered in the differential diagnosis of unusual calcified subcutaneous lesions. Integrated clinical, radiological, cytological, and histopathological assessment helps avoid misdiagnosis and guides appropriate management.
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Copyright (c) 2026 Nalla Mamatha, Sravanthi Gurugubelli, P. Sandya Rani Guruvelli, Shaik Adeeba Fathima, Atla Bhagya Lakshmi (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
