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Clinical Problem Solving: Pathology
Apr 2012

Pathology Quiz Case 2: Diagnosis

Arch Otolaryngol Head Neck Surg. 2012;138(4):430-431. doi:10.1001/archoto.2011.1267b

Diagnosis: Metastatic calcium phosphate deposition secondary to chronic kidney disease (CKD)

Given the patient's history of CKD and hemodialysis, metastatic calcification of the nasal septum or manifestations of renal osteodystrophy, such as a healed brown tumor, should be suspected. The clinical differential diagnosis includes osteoma, ossifying fibroma, enchondroma, and low-grade chondrosarcoma with calcification. The histologic differential diagnosis includes metastatic calcification of normal soft tissue vs dystrophic calcification of previously inflamed nasal soft tissue. These conditions are often difficult to differentiate histologically, and the clinical history can lead to the correct diagnosis. Because of the patient's underlying renal disease and lack of nasal trauma or inflammation, the most likely diagnosis was metastatic calcification of the membranous nasal septum secondary to CKD.