Early heterotopic ossification on the former VATS port sites in a patient with secondary hyperparathyroidism

Secondary hyperparathyroidism is common in chronic end-stage renal failure. Increased levels of parathyroid hormone (PTH) can cause altered bone mineralization and metabolism. A 64-year-old male patient with end-stage renal failure and secondary hyperparathyroidism was referred for surgical treatment of right-sided pleural empyema. During the postoperative course two redo procedures were performed within 3 weeks. On the second re-intervention, 22 days after the initial operation, a subcutaneous/intermuscular "stone-hard " chest wall tumor measuring 6 x 5 cm was detected at the former subaxillary port site and the soft tissues on both other previous port sites were severely altered and hardened. Histologically, focal fibrosis and necrosis as well as extensive heterotopic ossification were detected. On postoperative day 11 after the last redo procedure, the patient was discharged in good clinical condition into a nursing home. The physiological inflammatory hyperactivity of repetitive postoperative wound healing processes in tissues with a deranged calcium and phosphate balance may have favored the emergence of the detected stone-like soft tissue tumor on the port sites in this patient with secondary hyperparathyroidism.