Cutaneous vascular calcification with ulceration in hyperparathyroidism

We report a histologically distinctive form of small blood vessel calcification that led to necrosis and ulceration of the skin. Microscopically, wedge-shaped ulcers of the skin and superficial subcutis were observed. Calcified deposits were identified in the walls of small blood vessels at the ulcer bases. Recanalized thrombi occluded the lumina of some of the calcified vessels. On the basis of these distinctive histologic findings, hyperparathyroidism was accurately predicted. These changes have previously been cited in the internal medicine and dermatology literature but, to our knowledge, not in the pathology literature. We believe that these lesions are not rare and are probably often overlooked by pathologists. The histologic and clinical findings in two cases are presented.