88 • C.-A. Baud and Christiane Kramar 



The microradiographs showed large areas with a high and 

 uniform degree of mineralization, and others characterized 

 by a lower degree of mineralization and the presence of some 

 lens-shaf)ed cavities of the size of the bone osteocytic la- 

 cunae. Examination of the decalcified sections showed areas 

 stained red with van Gieson's method, fibrillar texture, and 

 (jositive birefringence. Electron microscopic study indicated 

 the presence of collagen fibrils with characteristic striation; 

 these fibrils were scattered in highly mineralized zones and 

 packed close in a parallel direction in the less mineralized 

 ones. 



X-ray diffraction patterns were characteristic of apatite, 

 with large crystals in the more mineralized zones (fine lines) 

 and small crystals in the others (broad lines). 



After dissolution of apatite, we looked at the presence of 

 minerals known to provoke fibroses (Le Bouffant 1974): we 

 found nothing to support the hypothesis that minerals in the 

 environment of these individuals are agents in this etiology 

 (Constantopoulos et al. 1985). 



LEIOMYOMAS OF THE UTERUS 



Macroscopically the Neolithic leiomyoma was a spherical 

 mass (56 x 52 x 45 mm) with a smooth but irregular surface. 

 X-rays confirmed its mineralized nature. Examination of the 

 decalcified sections showed the presence of collagen fibers; 

 van Gieson's method stained them in red, and birefringence 

 was positive; no bone structure was observed. Microradio- 

 graphs showed a high and uniform mineralization. Electron 

 microscopy confirmed the presence of collagen fibrils with 

 the characteristic striation. The mineral material was apatite; 

 crystal size and/or perfection were good. 



The dimensions of the two others were 46 x 32 x 25 mm 

 (Sion Sous-le-Scex) and 30 x 26 x 18 mm (Ranees). The 

 section of these calcifications showed the characteristic 

 whorllike pattern of the leiomyoma (Bartholomew et al. 

 1961). 



A similar case of calcified uterine leiomyoma was reported 

 by Strouhal and Jungwirth (1977). 



LYMPH NODE 



The lymph node was a reniform mass (12x8 mm) with a 

 lamellar capsule with numerous perforations enclosing two 

 rounded nodules. Microradiographs of the sections showed 

 that both capsule and nodules were highly mineralized. His- 

 tological study of decalcified sections showed fibrillar struc- 

 ture with a positive birefringence and a red van Gieson's 

 staining, particularly in the surface layers of the node. X-ray 

 diffraction revealed two mineral components: apatite in the 

 periphery, and apatite together with whitlockite in the center, 

 as we observe in calcified tuberculous lesions (Lindgren 

 1961:81-89;Lagieretal. 1966; Sakae and Yamamoto 1987). 



The shape, size, and fibrous capsule with numerous perfora- 

 tions suggest a lymph node; calcified foci formed of apatite 

 and whitlockite suggest calcification of tuberculous origin. 



HYDATID CYST 



The cyst was an ovoid, hollow concretion 1 cm in diameter, 

 with a smooth internal surface and an irregular external sur- 

 face. The observation of a section with polarized light 

 showed tangled collagen fibrils. All these facts characterize 

 a cyst wall (Weiss and M0ller-Christensen 1971; Price 

 1975:366-367; Wells and Dallas 1976; Ortner and Putschar 

 1981). 



The mineral component was apatite only; this is compat- 

 ible with an hydatid cyst (Lagier et al. 1966: 158). 



Differential diagnosis of soft tissue 

 calcifications 



It is important to distinguish between ossifications, calcifica- 

 tions, and calculi. 



We have first to differentiate tissue calcifications from 

 calculi. Concretions in the body cavities (gastroliths, entero- 

 liths, bezoars, etc.) and calculi in excretory ducts (salivary, 

 biliary, urinary) also contain an organic matrix (Kahn and 

 Hackett 1984), but in small quantity and not of collagenous 

 nature (not stained with van Gieson's picrofuchsine). 



Among tissue calcifications we have to distinguish be- 

 tween a calcification and an ossification: calcification corre- 

 sponds to adeposit of mineral material in aconnective tissue, 

 more or less altered, which shows the presence of scattered 

 collagen fibrils and a very high degree of mineralization; 

 ossification has a characteristic texture with an oriented dis- 

 position of collagen fibrils and osteocytic lacunae. We have 

 to note that a tissue calcification tends to be replaced by an 

 ossification (Kuhlmann 1934), which explains the coexis- 

 tence, in pleural plaques, of ossified zones and calcified 

 zones. 



The study of the mineral component of a calcification can 

 permit the substantiation of an etiological diagnosis: most of 

 the soft tissue calcifications are formed of apatite only, and 

 they correspond to a broad spectrum of pathological condi- 

 tions (Lagier et al. 1966:158). Mixed crystal deposits, with 

 apatite and whitlockite, are found predominantly in lesions 

 of tuberculous or parasitic origin (Lagier et al. 1966:159). 



Literature cited 



Bartholomew, L.G., J.C. Cain, G.D. Davis, and A.H. Bulbulian. 

 1961 . Misleading Calcific Shadows in the Abdomen. Postgradu- 

 ate Medicine. 30:51-52. 



Baud, C.-A. 1972. Unc Plaque Pleurale Calcifiee: Etude Ultra- 

 structurale et Cristallographique. Genava. 20:196-199. 



Boivin, G., andC.-A. Baud. 1984. Microradiographic Methods for 

 Calcified Tissues. In G.R. Dickson, ed., Methods of Calcified 



Zagreb Pateopaiholofiy Symp. 1988 



