BRIEF COMMUNICATION Vulvar calcinosis in childhood Elisa Tomazzini a , Paulo Giraldo a, ⁎ , Rose Amaral a , José Eleutério Junior a,b , Maria L. Cintra c , Helena P. Donovan Giraldo d a Department of Gynecology and Obstetrics, The University of Campinas, School of Medical Sciences, São Paulo, Brazil b Division of Genital Tract Pathology and Colposcopy, Federal University of Ceará, Fortaleza, Brazil c Department of Pathological Anatomy, The University of Campinas, School of Medical Sciences, São Paulo, Brazil d Jundiaí Medical School, Jundiaí, São Paulo, Brazil Received 27 May 2008; received in revised form 1 July 2008; accepted 2 July 2008 KEYWORDS Cutaneous calcinosis; Juvenile; Vulvar calcinosis; Vulva tumor Cutaneous calcinosis is the term used to describe a group of disorders that involve the deposit of calcium in the skin. The first case was described by Virchow in 1855. Calcinosis is the result of the precipitation or deposit of insoluble calcium salts (calcium hydroxyapatite crystals) into tissues. The clinical presentation of lesions is typically papules and plaques that can be yellow-white or skin color, firm or hard, and which may or may not be painful. Calcinosis can be divided into 4 clinical types: dystrophic, metastatic, iatrogenic, and idiopathic. Dystrophic calcinosis can occur in areas of localized tissue injury or abnormality, such as alterations in collagen, elastin, or subcutaneous fat. Calcium and/or phosphate metabolism and serum levels are normal and internal organs are not usually affected. Metastatic calcinosis is the result of abnormal metabolism often associated with hypercalcemia or hyperphosphatemia, which can cause the calcification of cutaneous, subcutaneous, and deep tissues. It is usually associated with bone degeneration [1]. Idiopathic calcinosis occurs in the absence of tissue abnormalities or defects in calcium and/or phosphate meta- bolism [2]. Iatrogenic calcinosis can occur as a complication of intravenous treatments due to leakage of calcium solutions leading to calcified nodules at the injection site. A number of cases of scrotal skin calcinosis have been reported. However, the vulva is an unusual place for any form of calcification, and vulvar calcinosis is exceptionally rare. Only 8 cases have been described and 7 of these were in children, the last of which was described in 2002 [3]. There was no laboratory evidence of calcium or phosphorous dysfunction in any of the juvenile cases [2,3]. A 9-year-old premenarchal girl presented at the out- patient clinic for female genital infections with hardened lesions in the area of the labia major and pubis. The lesions had first been noticed 1 year previously, but had worsened 1 month prior to the visit. Sexually transmitted diseases were suspected but the patient denied any sexual contact, abuse, or trauma and had not experienced pain, heat, or secretions from the lesions. Physical examination showed multiple tumor lesions (the largest of approximately 0.6 cm in diameter) distributed along the labia major and pubis (Fig. 1). Histopathologic evaluation led to a diagnosis of cutaneous calcinosis. All laboratory values were within normal reference ranges (urine volume 1370 mL/24 hours) total calcium 9.60 mg/dL; urinary calcium 67.13 mg/1370 mL (24 hours); alkaline phosphatase 186 u/L; potassium 4 mEq/L; urinary potassium 36.44 mEq/1370 mL (24 hours); inorganic ⁎ Corresponding author. Tel.: +55 19 35219306; fax: +55 19 35219306. E-mail address: giraldo@unicamp.br (P. Giraldo). 0020-7292/$ - see front matter © 2008 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2008.07.003 available at www.sciencedirect.com www.elsevier.com/locate/ijgo International Journal of Gynecology and Obstetrics (2008) xx, xxx–xxx ARTICLE IN PRESS IJG-06008; No of Pages 2 Please cite this article as: Tomazzini E, et al, Vulvar calcinosis in childhood, Int J Gynecol Obstet (2008), doi:10.1016/j.ijgo.2008.07.003