Extraskeletal tumoral calcinosis is a rare metabolic disorder and occurs in uremic patients with high calcium phosphorus (CaxP) product and progressive secondary hyperparathyroidism. Local factors are also involved in addition to increased calcium and phosphate levels. An inflammatory response occurs and a fibrous wall surrounds the calcium phosphate deposits. These encapsulated tumoral deposits are localized around joints and usually do not affect function. They remain clinically silent in most cases but may become symptomatic in a minority of patients and require surgical treatment. We describe four patients with tumoral calcinosis and chronic renal failure undergoing hemodialysis treatment. Two of the four patients had undergone renal transplantation but had developed chronic rejection. Case one, a 42-year-old man had multiple soft-tissue calcifications of the hands and feet of a various sizes (1x1-3x5 cm) causing dysfunction and pain. Case 2, a 36-year-old woman had 12x12 cm mass at the insertion of the iliopsoas muscle. Case 3, a 31-year-old man had 3x5 cm tumoral calcinosis in the right foot adjacent to the fifth MTP joint. Case 4, a 45-year-old male, had 3x3 cm mass in the right anatomic snuff-box, the site of a previous arterio-venous fistula. The indication for surgery was pain unresponsive to conservative measures. No patient had neuro-vascular compromise. Parathormon levels were all less than 300 pg/ml at operation time. The tumoral masses were marginally excised. All continued on a program of dialysis with orally administered phosphate binding compounds. At minimum 2-year follow-up, case 1 had a recurrent lesion in the hand, other cases were asymptomatic. Soft-tissue calcifications are frequently seen in patients with chronic renal failure, especially in those on long-term hemodialysis. To prevent this complication, CaxP product must be under 55 and adenoma of parathyroid gland must be excluded before intravenous Dihydroxyvitamin D(3) (calcitriol) therapy. Surgical excision may be required for symptomatic lesions.