Scrotal calcinosis results from calcification of cysts derived from hair follicles: a series of 20 cases evaluating the spectrum of changes resulting in scrotal calcinosis.

Scrotal calcinosis is a rare disorder characterized by multiple papules or nodules of calcification in the scrotal skin. The etiology of this entity is speculative largely as a result of the paucity of larger series.This study of 20 patients with scrotal calcinosis was undertaken to critically analyze the histology with a view to assess the probable etiology of this lesion. Two thirds of the patients were young adults. Of these, 11 patients (55%) were asymptomatic and 9 complained of symptoms related to the breakdown of these lesions (eg, discharge, itching, or heaviness in the scrotum). All cases showed classical histologic features of scrotal calcinosis with a variable amount of calcification in the dermis. In 14 cases the etiology of this calcification could be traced to originate from dilated epidermal cysts. The spectrum of changes probably started with the cystic dilation of the hair follicle, then calcification around and within this cyst. Finally the epithelial elements disappeared, leaving behind residual areas of calcification. The remaining 6 cases did not have epithelial cysts in the vicinity. Based on these observations we conclude that scrotal calcinosis results from calcification of hair follicular or epidermal cysts, but as most of the cases report, this epithelium disappears and may not be seen.