Calcinosis Mimicking Tumor: A Rare Case Report

Background: Scapula is a common site for bony and soft tissue lesions. However, due to the vast number of lesions presenting around the scapula and their relatively low incidence, diagnosis is often missed or delayed, thereby affecting the clinical outcome. Common lesions around the scapula are osteochondromas, osteosarcoma, chondrosarcoma, etc. We present a case of a 12-year-old female child with a scapula mass, which was reported ambiguously in multiple radiographic investigations as well as biopsies. Case: A 12-year-old female patient presented to the outpatient department with complaints of swelling in the right scapular region along with difficulty in range of motion (ROM) and chest pain. The mass had irregular margins and was non-tender. A computed tomography scan was suggestive of Parosteal osteosarcoma involving the scapula, serratus anterior, latissimus dorsi, and parietal pleura. Magnetic resonance imaging was suggestive of a primary neoplastic lesion. Blood reports revealed hyperphosphatemia. A J needle biopsy was inconclusive. The patient was managed with In-toto excision of the mass. The inferior angle of the scapula had to be removed as the mass was adhered to it. Histopathological examination (HPE) was suggestive of tumor calcinosis. The patient was started with physiotherapy as per pain tolerance immediately. The patient was followed for 6 months. There was no clinical or radiological evidence of recurrence, and the patient regained her complete ROM without pain. Results: The patient was followed up for six months, during which no clinical or radiological signs of recurrence were observed. She regained full, pain-free range of motion. The patient is able to do activities of daily living. Conclusion: Scapula is often affected by multiple pathologies of varying origins, which have morphological and radiological resemblances leading to confusion and delayed diagnosis. A comprehensive clinical evaluation, along with correlating metabolic and radiological investigations, may suggest a diagnosis; however, definitive confirmation should always be obtained through excision and histopathological examination (HPE). Keywords: Tumour calcinosis, Scapula, Osteosarcoma.