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NDT Plus Advance Access published online on September 9, 2009
NDT Plus, doi:10.1093/ndtplus/sfp115
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Ectopic ossification in the cranial dura mater in dialysis patients with secondary hyperparathyroidism

Yuko Oyama1, Junichiro J. Kazama2, Mitsutoshi Fukagawa1, Yasuaki Arakawa3 and Isamu Ezuka3

1 Division of Nephrology, Joetsu General Hospital, Joetsu
2 Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata
3 Division of Brain Surgery, Joetsu General Hospital, Joetsu, Japan

Correspondence: Junichiro J. Kazama; E-mail: jjkaz{at}med.niigata-u.ac.jp


  Abstract

We report the case of a 69-year-old woman with secondary hyperparathyroidism who underwent maintenance haemodialysis therapy for 17 years and who presented with severe dural calcification and right subdural haematoma. Her dura mater displayed a rock barnacle-like appearance, and cerebral superficial arteries adhered to the sclerotic lesions. On the microscopic observation, calcified tissue with a clear lamellar structure and osteopontin immunoreactivity was observed. Tartrate-resistant acid phosphatase immunoreactive polynucleated giant cells infiltrated around the tissue. Such morphological properties are specific to the calcified tissue formed through a bone formation-like mechanism that is often observed in arterial media in patients with chronic kidney disease.

Key Words: dura matter • ectopic ossification • secondary hyperparathyroidism • subdural haematoma • tartrate-resistant acid phosphatase

Received for publication May 7, 2009. Accepted for publication July 30, 2009.


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