Pathologic calcification: is the deposition of calcium salts, together with small amounts of iron,
magnesium, and other mineral salts in the tissue other than bone or enamel.
DYSTROPHIC CALCIFICATION
Definition Dystrophic calcification; deposition of calcium salts in
dead & dying tissue with normal serum calcium.
Normal serum Calcium level
Mechanism
of  It occurs as a reaction to tissue damage or
necrosis.
Calcificatio
n  Dystrophic calcification is initiated by the
extracellular deposition of crystalline calcium
phosphate in membrane-bound vesicles, which
may be derived from injured cells, or the
intracellular deposition of calcium in the
mitochondria of dying cells.
 The extracellular calcium is concentrated in
vesicles by its affinity for membrane phospholipids.
 The activated membrane bound
phosphatases generate phosphates, which bind to
the calcium ions and form calcium phosphate.
 The crystals are then propagated, forming larger
deposits.
METASTATIC CALCIFICATION
Metastatic calcification: deposition of calcium
salts in normal tissues due to hypercalcemia.
Hypercalcemia
Four principal causes of hypercalcemia:
(1) Increased secretion of parathyroid
hormone:
 Hyperparathyroidism due to
parathyroid tumors.
 Ectopic secretion of PTH-related
protein by malignant tumors.
(2) Bone destruction:
 Primary tumors of bone marrow e.g.
multiple myeloma, leukemia.
 Secondary/metastatic tumors of bone e.g.
breast, colorectal carcinoma.
 Accelerated bone turnover e.g., Pagets
disease.
 Immobilization.
(3) Vitamin D–related disorders:
 Vitamin D intoxication
 Sarcoidosis (in which macrophages activate
a vitamin D precursor),
 Idiopathic hypercalcemia of infancy
(Williams syndrome), characterized by
abnormal sensitivity to vitamin D.
 (4) Chronic Renal failure: which causes retention
of phosphate, leading to secondary
hyperparathyroidism.

Less common causes :

 Aluminum intoxication.
 Milk-alkali syndrome

Sites Calcification in dead tissue

1. Caseous necrosis in T.B. is most common site of

dystrophic calcification.
2. Liquefactive necrosis in chronic abscesses.
3. Fat necrosis following acute pancreatitis or
traumatic fat necrosis in breasts.
4. Infarcts .
5. Thrombi, especially in veins, may
produce phleboliths.
6. Hematomas
7. Dead parasites like Schistosoma eggs may calcify.
8. Congenital toxoplasmosis or rubella may be seen
on X-ray as calcifications in the brain.
Calcification in degenerated tissue
The interstitial tissues of the kidneys, lungs,
gastric mucosa, systemic arteries & veins.
The deposition of calcium occurs in those organs
and tissues where there is an acid to alkaline
interconversion or those organs that ‘lose’ acid and
have an internal alkaline compartment.
Gastric mucosa, Kidneys & lung tissues excrete
acid and therefore have an internal alkaline
compartment that predisposes them to metastatic
calcification.

1. Dense/ old scars

2. Atheroma in aorta
3. Cysts wall
4. Old and damaged heart valves.
5. Neoplasms: necrotic areas in any tumors may
have foci of calcification.
 Examples: Papillary carcinoma of thyroid,
Papillary serous carcinoma of ovary, Breast
carcinoma etc.

Meningioma is a benign brain tumor containing

foci of calcification.

Gross Fine, white granules or clumps, often felt as gritty Fine, white granules or clumps, often felt as gritty
deposits. deposits

Microscopy Microscopy: with the usual hematoxylin and eosin

Microscopy: with the usual hematoxylin and eosin stain, stain, calcium salts have a basophilic, amorphous
calcium salts have a basophilic, amorphous granular, granular, appearance.
appearance.