Pathological Calcification by Khubaib Samdani Learning Objectives: Definition Classification Quick Comparison Morphology Dystrophic Calcification (etiology, pathogenesis) Metastatic Calcification

1. PATHOLOGICAL
CALCIFICATION
Khubaib Samdani
Rawalpindi Medical University
khubaibsamdani

2.  abnormal deposition of calcium salts
 with smaller amounts of iron, magnesium
and other mineral salts
 at sites other than osteoid and enamel
definition

3.  dystrophic calcification
 metastatic calcification
classification

4. Dystrophic
Calcification
Metastatic
Calcification
Location In
dead or dying tissue
In apparently normal
tissue
Calcium metabolism Normal Abnormal
Serum calcium Normal (8.5-10.2 mg/dL) Hypercalcemia (> 10.2
mg/dl)
Reversibility Irreversible Reversible (upon
correction of metabolic
disorder)
QUICK COMPARISON

5. MORPHOLOGY
Etiology and pathogenesis of the two are different.
But morphologically the deposits in both resemble normal minerals
the bone.
In H&E stained sections, calcium salts appear as deeply basophilic,
irregular and granular clumps. The deposits may be intracellular,
extracellular, or at both locations.

6. 1. DYSTROPHIC CALCIFICATION
Etiology:
Usually found incidentally in areas of necrosis of any type,
Indicating insignificant past cell injury, it may also be a cause of organ dysfunction
May occur due to 2 types of causes:
o Death of tissue
o Degeneration of tissue

7. Dystrophic calcification in aortic valve

8. Caseous necrosis in tuberculous lymph
node showing dystrophic calcification
(most common site)

10. Liquefaction necrosis in chronic abscesses may get calcified

11. Fat necrosis following acute pancreatitis or traumatic fat
necrosis in the breast results in deposition of calcium soaps

12. Dystrophic calcification in artery

13. Dystrophic calcification in the wall of the stomach

14. Mammogram showing dystrophic calcification

15. Psammoma bodies or calcospherites: characteristic
spherules of calcification/lamellated bodies such as in meningioma, papillary
serous cystadenocarcinoma of the ovary and papillary
carcinoma of the thyroid

16. Pathogenesis:
2 phases
o initiation (/nucleation)
o propagation

19. 2. METASTATIC CALCIFICATION
Calcification in normal tissue whenever there is hypercalcemia
These may be due to
– Excessive mobilization of calcium from the bone
– Excessive absorption of calcium from the gut

20. Etiology
 Excessive mobilization of calcium from the bone
Hyperparathyroidism
Primary : parathyroid adenoma,
Secondary: parathyroid hyperplasia, chronic renal failure
Destruction of bone tissue
multiple myeloma, leukemia metastatic carcinoma,
a. Primary tumors of bone marrow like:
multiple Myeloma, leukemias
b. Diffuse skeletal metastasis (e.g., breast cancer)
c. Accelerated bone turn over like in Paget disease
Prolonged immobilization
disuse atrophy of the bones and hypercalcaemia

21.  Excessive absorption of calcium from the gut
Hypervitaminosis D/ Vitamin D intoxication
Milk-alkali syndrome

22. Metastatic Calcification
Liver
Lungs
Kidneys

23. Metastatic Calcification in lungs

24. And that concludes the presentation
Shukriya!