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Definition

Pathological Calcification is a

common process in a wide variety of disease states, it implies the abnormal deposition of Calcium salts, together with small amounts of iron,Mg and other minerals.

Types of Calcification
Dystrophic Calcification Metastatic Calcification

Dystrophic Calcification
When deposition occurs in dead or dying tissues, it is dystrophic calcification. It occurs in absence of calcium metabolic derangements (i.e. with normal serum levels of calcium)

Etiology of Dystrophic Calcification


Dystrophic Calcification can develop in
Aging or damaged heart valves Aged pineal gland Dead parasites Dead retained Fetus Atheromas Areas of Necrosis Carcinomas

Morphology of Dystrophic Calcification


Regardless of sight, Ca salts are grossly seen as fine white granules or clumps, of ten felt as gritty deposits. Sometime a tuberculous lymph node is essentially converted to radio opaque stone.

(contd.)
Calcium appears in intracellular or extracellular basophilic deposits. Hypertrophic bone may be formed in the focus of calcification.

Pathogenesis of Dystrophic Calcification


INITIATION Calcium from mitochondria Calcium combines with phospholipids in cell membrane Membrane associated phosphatases generate phosphate groups that bind to bound Ca

Pathogenesis of Dystrophic Calcification


PROPAGATION Cycle of Ca and PO4 binding is repeated again and again Micro crystals develop after rearrangement in PO4 and Ca ions Dystrophic Calcification

Metastatic Calcification
The deposition of Calcium salts in normal tissues is known as Metastatic Calcification. Metastatic Calcification can occur in normal tissue whenever there is hypercalcaemia.

Etiology of Metastatic Calcification


Increased secretion of Parathyroid hormone with

subsequent bone resorption seen in: a) Hyperparathyroidism due to PH tumors b) Ectopic secretion of PH by malignant tumors Destruction of bone tissue seen with: a) Primary tumors of bone marrow like multiple myeloma & leukemis b) Diffuse skeletal metastasis

(contd.)
Renal failure causes retention of PO4 leading to

secondary hyperparathyroidism. Vitamin D related disorders: a) Vitamin D intoxication b) Sarcoidosis

Morphology of Metastatic Calcification


Metastatic calcification can occur widely throughout the body but principally affects the interstitial tissues of vasculature, kidneys, lungs and gastric mucosa. The Ca deposits morphologically

(Contd..)
resemble those described in dystrophic calcification Although they do not, generally, cause clinical dysfunction, extensive calcifications in the lungs may produce remarkable

(Contd..)
radiographs & respiratory deficits and massive deposits in the kidney (nephrocalcinosis) can cause renal damage.

Pathogenesis of Dystrophic Calcification


It is related to traveling tumors from one place in body to other. In some cases we have extensive bone destruction and this is mainly in METASTATIC BONE CANCERS. Many cancers -in there last stages- deposit some of the malignant tumor outside the original organ, like breast, prostate or thyroid tumor. Part of the tumor will go by the blood stream or the lymphatics to spread and destroy the bone and (Ca+2) will be released.

Abnormal intracellular depositions and calcifications


1) Deposition of Lipids
a) Fatty change: Accumulation of free triglycerides in cells resulting from excessive intake or defective transport ;manifestation of reversible cell injury. b) Cholesterol deposition: Result of defective catabolism and excessive intake, in macrophages and smooth muscle cells of vessel walls in atherosclerosis.

2) Deposition of Proteins
a) Reabsorbed proteins in kidney tubules. b) Immunoglobulins in plasma cells.

(Contd..)
3) Deposition of Glycogen
Deposition of glycogen in macrophages of patients with defects in lysosomal enzymes that break down glycogen (Glycogen storage disorders).

4) Deposition of Pigments
Indigestible pigments such as carbon, lipofuscin (breakdown product of lipid peroxidation),iron (due to overload as in hemosidrosis ).

Effects of Calcification
Heart
Certain type of cancerous tumors and tissue damage that causes atherosclerosis or clogged, hardened arteries that result in heart attack.

Brain
Calcifications found in arteries that lead to brain such as those in neck and spine can cause a stroke.

Breasts
Calcifications is most often benign but in some cases may indicate malignancy.

(Contd..)
Joints
Joints become inflamed, painful and their movements become limited.

Cartilage
Calcium crystals lead to erosion of cartilage.

Kidney
IF calcium kidney stones are large or have jagged edges, they can cause extreme pain as they travel through the urinary tract and may cause a blockage that can lead to kidney failure.