CALCIPHYLAXIS
Calciphylaxis presents as painful, indurated, focally necrotic, erythematous plaques that usually are on extremities. Secondary hyperparathyroidism resulting from chronic renal failure treated by dialysis is the most common association. Calcification of small blood vessels, focal calcification of the fat, and vascular thrombosis are seen histopathologically. The degree of necrosis of the dermis and/or lobular panniculitis is variable within a given lesion, and this is reflected in the highly variable pathology seen in multiple biopsies of a lesion or from case to case. Either a large biopsy or multiple biopsies that include subcutis may be necessary to demonstrate the calcification. Necrosis of the dermis and/or the vasocentric nature of the calcification in calciphylaxis help distinguish this from the calcification sometimes associated with pancreatic fat necrosis involving the subcutis.

This 66 year old male, who has been on dialysis for renal failure, developed bilateral, indurated, erythematous, painful plaques about 10 cm. in diameter on the thighs. Focal necrosis was noted clinically. This patient had secondary hyperparathyroidism, and he also had focal superficial penile ulcers. The penis was not biopsied, but an x-ray set for soft tissue density demonstrated calcification within it.
Scan power view. The skin does not look too remarkable at this magnification, but there is something abnormal in the lower right side of the reticular dermis.
A low power view of the lower right side of the reticular dermis. This biopsy was taken near the edge of a focus of clinical necrosis. The PMN's and nuclear debris scattered between collagen bundles are consistent with the reaction on the edge of a necrotic zone.
A medium power view above the zone shown above. The collagen bundles are swollen, and there is a marked diminution in the number of fibroblasts that would normally be present. This can be seen in dermis that has a diminished blood supply.
A high power view of a calcified, tiny blood vessel. Very few small blood vessels having this finding were demonstrated.
A high power view of a larger focus of calcification, possibly of a blood vessel. Foci such as this were not plentiful in the biopsy.
A medium power view of two thrombosed blood vessels.

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