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Srinivasan S, Raju B, Nair R, Hegde A, Johnson S, Menon G. Brown Tumor of the Dorsal Spine With Hemorrhage Causing Acute Neurological Deterioration: A Rare Presentation of Secondary Hyperparathyroidism. Cureus 2024; 16:e63645. [PMID: 39092321 PMCID: PMC11292460 DOI: 10.7759/cureus.63645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
Brown tumor due to secondary hyperparathyroidism in chronic kidney disease is a well-established entity. Brown tumor of the spine with hemorrhage causing acute neurological deficit is a rare entity. A 35-year-old gentleman, with chronic kidney disease (CKD) on dialysis, presented with acute paraplegia and loss of lower limb sensation and bowel and bladder control. Imaging revealed a T8 vertebral body expansile lytic lesion with collapse, exaggerated kyphosis, and cord compression. He underwent an emergency decompressive laminectomy and transpedicular corpectomy of T8, with posterior stabilization. Histopathology revealed lobular clusters of osteoclast-like multinucleated giant cells with background of which was possibly the reason for acute neurological deterioration in this case. Brown tumors of the spine can mimic lytic lesions of the spine like myeloma and metastasis. Suspicion must be raised given in the setting of CKD and hyperparathyroidism. They can present with hemorrhage and acute neurological deficit, which warrants urgent surgical intervention for optimal outcomes.
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Affiliation(s)
| | - Bharat Raju
- Neurosurgery, Kasturba Medical College, Manipal, Manipal, IND
| | - Rajesh Nair
- Neurosurgery, Kasturba Medical College, Manipal, Manipal, IND
| | - Ajay Hegde
- Neurosurgery, Manipal Hospitals, Bangalore, IND
| | | | - Girish Menon
- Neurosurgery, Kasturba Medical College, Manipal, Udupi, IND
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Liu Z, Yang H, Tan H, Song R, Zhang Y, Zhao L. Brown tumor of the cervical spine with primary hyperparathyroidism: A case report and literature review. Medicine (Baltimore) 2023; 102:e32768. [PMID: 36820584 PMCID: PMC9907965 DOI: 10.1097/md.0000000000032768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
RATIONALE Brown tumor (BT), an uncommon focal lytic bone tumor, is a non-neoplastic and reactive process caused by increased osteoclastic activity and fibroblastic proliferation in primary or secondary hyperparathyroidism. Vertebral tumor causing neural compression is relatively rare, especially in the cervical spine. PATIENT CONCERNS A 29-year-old man developed neck pain and arm radicular pain 4 months ago, with the level of serum calcium significantly higher than normal. Computed tomography scan of the cervical spine revealed an expansile lytic lesion occupying the C6 body, left pedicle, and left lamina of C5-6. DIAGNOSES Osteoclastoma according to imaging and histopathological results. INTERVENTIONS A laminectomy of C5-6 was performed. OUTCOMES One month later, he was re-hospitalized due to nausea and vomiting and the serum calcium, was still, kept at a high level. Additionally, the parathormone (PTH) was greatly higher than normal. BT with primary hyperparathyroidism due to the parathyroid tumor was considered. After the surgery of the right parathyroid gland was performed, serum calcium and PTH both decreased, and computed tomography showed good recovery. LESSONS BTs might be misdiagnosed as other giant cell tumors, thus when giant cell tumors are considered, serum calcium and PTH examination may be needed to exclude BTs.
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Affiliation(s)
- Zirui Liu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Yang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongyu Tan
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruipeng Song
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- * Correspondence: Liang Zhao, Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (e-mail: )
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Srikantha U, Hari A, Lokanath YK, Mahesh DM. A rare case of "Brown tumor" of the axis with parathyroid adenoma and tertiary hyperparathyroidism. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:97-102. [PMID: 37213580 PMCID: PMC10198211 DOI: 10.4103/jcvjs.jcvjs_144_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 12/25/2022] [Indexed: 03/16/2023] Open
Abstract
"Brown tumors (BTs)" of the spine are benign rare lesions, seen in about 5%-13% of all patients with chronic hyperparathyroidism (HPT). They are not true neoplasms and are also known as osteitis fibrosa cystica or occasionally osteoclastoma. Radiological presentations are often misleading and may mimic other common lesions such as metastasis. A strong clinical suspicion is therefore necessary, especially in the background of chronic kidney disease with HPT and parathyroid adenoma. Surgical spinal fixation in case of instability due to pathological fracture may be required along with excision of the parathyroid adenoma being the treatment of choice, that maybe usually curative and carries a good prognosis. We would like to report one such rare case of BT involving the axis, or C2 vertebra, presenting with neck pain and weakness that was treated surgically. Only a few cases of spinal BTs have been reported so far in the literature. Involvement of cervical vertebrae and in particular C2 is rarer still with the one in this report only being the fourth such case.
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Affiliation(s)
- Umesh Srikantha
- Department of Neurosurgery, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Akshay Hari
- Department of Neurosurgery, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Yadhu K Lokanath
- Department of Neurosurgery, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - D. M. Mahesh
- Department of Endocrinology, Aster CMI Hospital, Bengaluru, Karnataka, India
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Muacevic A, Adler JR, Caridade S. Secondary Hyperparathyroidism Presenting as a Brown Tumor: A Case Report and Review of the Literature. Cureus 2023; 15:e33820. [PMID: 36819315 PMCID: PMC9930372 DOI: 10.7759/cureus.33820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/18/2023] Open
Abstract
Severe secondary hyperparathyroidism in advanced stages of chronic kidney disease (CKD) is associated with CKD-related mineral and bone disease (CKD-MBD). A 70-year-old woman was admitted at the Hospital for generalized bone pain and peripheral edema. Initial laboratory tests revealed normocytic anemia and severe renal dysfunction, and further tests evidenced severe secondary hyperparathyroidism. Full-body computerized tomography showed an osteolytic lesion in the right iliac wing. The iliac bone lesion was biopsied and histological examination was consistent with the diagnosis of a brown tumor of hyperparathyroidism. Brown tumors are a rare variant of osteitis fibrosa cystica that results from sustained high levels of parathyroid hormone in CKD. This case sheds light on rare complications that are experienced today in CKD. The clinical and biochemical setting, as well as the clinical suspicion, are essential to the diagnosis.
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Panwar J, Bhat TA, Ballabh S, Abraham D, Jebasingh FK. A Rare Case of Primary Hyperparathyroidism Presenting as a C2 Brown Tumor-Plain Radiography Has yet again Proved Indispensable in Clinching the Diagnosis. Indian J Radiol Imaging 2022; 32:615-620. [DOI: 10.1055/s-0042-1755266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractA brown tumor is one of the manifestations of hyperparathyroidism. It is a rare type of bone lesion that most often occurs in mandible, ribs, and large bones. Spinal involvement is extremely rare. We report an unusual case of a brown tumor of the axis vertebra in a 33-year-old male who presented to the orthopaedic clinic with posttraumatic C2 vertebra fracture and myelopathy. To plan further fixation and stabilization of C2 fracture, the patient underwent a plain radiograph and magnetic resonance imaging (MRI) of the cervical spine. The available routine chest radiograph at the time of MRI reporting clinched the diagnosis of primary hyperparathyroidism with a brown tumor of the axis vertebra. Thus, familiarity with subtle radiographic findings of this condition not only led to early diagnosis and appropriate treatment but also avoided unnecessary C2 biopsy and hardware fixation.
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Affiliation(s)
- Jyoti Panwar
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Tameem A. Bhat
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Saket Ballabh
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Deepak Abraham
- Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Felix K. Jebasingh
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Mirzashahi B, Vosoughi F, Besharaty S, Satehi SH. Missed C5 vertebral brown tumor causing spinal cord compression and myelopathy: A case report and literature review. Clin Case Rep 2022; 10:e05331. [PMID: 35127095 PMCID: PMC8795921 DOI: 10.1002/ccr3.5331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/28/2021] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
We aim to report a patient with vertebral brown tumor in the context of a primary hyperparathyroidism presented by shoulder pain. This is the first report of C5 brown tumor involvement in a primary hyperparathyroid patient and emphasizes the consideration of cervical vertebral evaluation in patients with persistent shoulder pain.
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Affiliation(s)
- Babak Mirzashahi
- Orthopedic Surgery DepartmentImam Khomeini HospitalTehran University of Medical SciencesTehranIran
| | - Farzad Vosoughi
- Orthopedic Surgery DepartmentImam Khomeini HospitalTehran University of Medical SciencesTehranIran
| | - Saied Besharaty
- Orthopedic Surgery DepartmentImam Khomeini HospitalTehran University of Medical SciencesTehranIran
| | - Sadegh Hasani Satehi
- Orthopedic Surgery DepartmentImam Khomeini HospitalTehran University of Medical SciencesTehranIran
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Ghernautan V, Idrees Z, Nassar M, Ciobanu C, Ramdass A. Brown Tumor With Spine Involvement at Multiple Levels in a Hemodialysis Patient. Cureus 2021; 13:e17000. [PMID: 34540402 PMCID: PMC8423116 DOI: 10.7759/cureus.17000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/18/2022] Open
Abstract
Brown tumor of the bone or osteitis fibrosa cystica is a rare manifestation of hyperparathyroidism, most seen nowadays in association with secondary and tertiary hyperparathyroidism. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are the major culprits of secondary hyperparathyroidism (sHPTH). CKD is known to cause phosphate retention and a decrease in 1,25-dihydroxyvitamin D and ionized calcium levels, which in turn trigger the PTH secretion. Brown tumor can affect the jawbones, femur, sternum, ribs, and rarely the spine. We present the case of a 60-year-old male with ESRD on hemodialysis who was found to have lytic bone lesions in the thoracic and lumbar spine. Initially, malignancy was suspected. Blood work revealed markedly elevated PTH at 3,563 pg/mL, hypocalcemia, and hyperphosphatemia. Biopsy of the L5-S1 lesion was consistent with reactive changes due to sHPTH. Once a diagnosis of the brown tumor was confirmed, the patient was started on cinacalcet and was referred for parathyroidectomy.
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Affiliation(s)
- Victoria Ghernautan
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals Queens, New York, USA
| | - Zarwa Idrees
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals Queens, New York, USA
| | - Mahmoud Nassar
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals Queens, New York, USA
| | | | - Adesh Ramdass
- Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals Queens, New York, USA
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8
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Wiederkehr M. Brown tumor complicating end-stage kidney disease. Clin Nephrol Case Stud 2020; 8:72-79. [PMID: 33062583 PMCID: PMC7552353 DOI: 10.5414/cncs110195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
Longstanding, severe hyperparathyroidism (HPT) can lead to the formation of "brown tumors". A brown tumor is a radiolucent bone lesion that is locally destructive; it is not a neoplasm, but rather a stromal mass consisting of fibrous tissue, poorly mineralized woven bone, and supporting vasculature. These tumors are a rare complication of advanced primary or secondary HPT. We present a young female with chronic kidney disease (CKD) on hemodialysis with uncontrolled secondary HPT (SHPT). The patient presented with progressive lower extremity weakness and back pain. CT imaging showed multiple lytic bone lesions involving several ribs and the spine. Subsequent MRI imaging of the thoracic and lumbar spine confirmed expansile bone lesions consistent with brown tumors. One mass protruded into the spinal canal causing severe stenosis at T3 with underlying cord edema. The other lesion at T12 caused only moderate spinal canal stenosis. Our patient underwent urgent neurosurgical resection of the tumor at T3 followed by subtotal parathyroidectomy (PTX).
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Affiliation(s)
- Michael Wiederkehr
- Department of Internal Medicine, Texas A&M Health Science Center, College of Medicine, Baylor University Medical Center, Dallas, TX, USA
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9
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Jia Q, Gao X, Zhou Z, Lan B, Zhao J, Liu T, Yang X, Wei H, Xiao J. Urgent surgery for spinal instability or neurological impairment caused by spinal brown tumors occurring in the context of end-stage renal disease. J Neurosurg Spine 2019; 30:850-857. [PMID: 30835712 DOI: 10.3171/2018.12.spine181044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal instability or neurological impairment caused by spinal brown tumors (BTs) with end-stage renal disease (ESRD) is an acute condition that needs urgent surgery. There is not much published information on BTs of the mobile spine given the rarity of the disease, and the literature shows inconsistent treatment options and ambiguous follow-up information. The aim of the present study was to elucidate the clinical features, anesthesia management, and surgical treatment for this rare disease through long-term follow-up observations. METHODS Clinical, laboratory, radiological, and perioperative data on 6 consecutive patients with spinal BTs who had been admitted to the authors' institution between 2010 and 2016 were retrospectively reviewed. The literature on spinal BT with secondary hyperparathyroidism was also reviewed. Summaries of the clinical features and anesthesia management are provided. RESULTS The mean age of the 6 patients was 45.5 years (range 35-62 years). Lesions were located in the cervical segment (2 cases) and thoracic segment (4 cases). Localized pain was the most common complaint, and pathological fracture occurred in 5 patients. Elevation of serum alkaline phosphate (AKP) and parathyroid hormone (PTH) was a common phenomenon. Four patients underwent circumferential resection and 2 underwent laminectomy, with parathyroidectomy performed in all patients. The anesthesia process was uneventful for all patients. The mean follow-up was 33 months (range 26-40 months). No spinal lesion progression occurred in any patient. The Karnofsky Performance Status score improved to 80-90 by 3 months after surgery. CONCLUSIONS Although uncommon, spinal BTs should be a diagnostic consideration in patients with ESRD. The thoracic spine is the most frequently affected site. ESRD is not a contraindication for surgery; with the assistance of experienced anesthesiologists, urgent surgery is the preferred option to alleviate neurological impairment and restore spinal stability.
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Affiliation(s)
- Qi Jia
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Xin Gao
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Zhenhua Zhou
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Bin Lan
- 2Medical Center of Military Unit 32151, Xingtai, Hebei, People's Republic of China
| | - Jian Zhao
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Tielong Liu
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Xinghai Yang
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Haifeng Wei
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Jianru Xiao
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
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10
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Liu YJ, Frauenhoffer EE, Walker E, Williams NC. A case report of brown tumor in a patient with chronic renal failure and renal cell carcinoma. Diagn Cytopathol 2017; 46:355-361. [PMID: 29193813 DOI: 10.1002/dc.23854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 09/19/2017] [Accepted: 10/23/2017] [Indexed: 11/08/2022]
Abstract
We report a case of a 72 year old male with hyperparathyroidism secondary to end stage diabetic renal disease and coexisting bilateral chromophobe renal cell carcinomas. The patient presented with back and groin pain, right pelvic hemorrhage, and multiple lytic bone lesions concerning for metastatic renal cell carcinoma. Fine needle aspiration cytology demonstrated benign appearing osteoclasts and spindled cells. A concurrent core biopsy showed foci of spindled cell proliferation populated by osteoclast-like giant cells with stromal hemorrhage without evidence of metastatic carcinoma. The cytologic and histologic findings, in correlation with the clinical history, radiographic features, markedly increased parathyroid hormone levels and other serologic studies, were diagnostic of the reactive lesion seen in brown tumor of hyperparathyroidism secondary to chronic renal failure.
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Affiliation(s)
- Yong-Jun Liu
- Department of Pathology, Penn State Health, Milton S. Hershey Medical Center & Penn State College of Medicine, Hershey, Pennsylvania
| | - Elizabeth E Frauenhoffer
- Department of Pathology, Penn State Health, Milton S. Hershey Medical Center & Penn State College of Medicine, Hershey, Pennsylvania
| | - Eric Walker
- Department of Radiology, Penn State Health, Milton S. Hershey Medical Center & Penn State College of Medicine, Hershey, Pennsylvania.,Department of Radiology and Nuclear Medicine, Uniformed University of the Health Sciences, Bethesda, Maryland
| | - Nicole C Williams
- Department of Pathology, Penn State Health, Milton S. Hershey Medical Center & Penn State College of Medicine, Hershey, Pennsylvania
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Heidarpour M, Karami M, Hedayat P, Aminorroaya A. Two rare manifestations of primary hyperparathyroidism: paralysis and peptic ulcer bleeding. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170059. [PMID: 28721219 PMCID: PMC5510439 DOI: 10.1530/edm-17-0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 06/22/2017] [Indexed: 12/14/2022] Open
Abstract
Primary hyperparathyroidism revealed by thoracic spine brown tumor and peptic ulcer bleeding is rare. We presented a case of 33-year-old male patient who was admitted with paraplegia. Thoracic spine magnetic resonance imaging (MRI) showed extradural lesion at T4 level. He underwent surgical decompression in T4. According to histopathologic finding and elevated serum parathormone (PTH) and hypercalcemia (total serum calcium 12.1 mg/dL), the diagnosis of brown tumor was down. Ultrasonography of his neck showed a well-defined lesion of 26 × 14 × 6 mm. The day after surgery, he experienced 2 episodes of melena. Bedside upper gastrointestinal endoscopy showed gastric peptic ulcer with visible vessel. Treatment with intragastric local instillation of epinephrine and argon plasma coagulation was done to stop bleeding. After stabilization of the patient, parathyroidectomy was performed. Histologic study showed the parathyroid adenoma without any manifestation of malignancy. At discharge, serum calcium was normal (8.6 mg/dL). On 40th day of discharge, standing and walking status was normal.
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Affiliation(s)
- Maryam Heidarpour
- Isfahan University of Medical Sciences Isfahan Endocrine and Metabolism Research Center Ringgold Standard Institution, IsfahanIran
| | - Mehdi Karami
- Isfahan University of Medical Sciences Isfahan Endocrine and Metabolism Research Center Ringgold Standard Institution, IsfahanIran
| | - Pegah Hedayat
- Isfahan University of Medical Sciences Isfahan Endocrine and Metabolism Research Center Ringgold Standard Institution, IsfahanIran
| | - Ashraf Aminorroaya
- Isfahan University of Medical Sciences Isfahan Endocrine and Metabolism Research Center Ringgold Standard Institution, IsfahanIran
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12
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Exoftalmos e hiperparatiroidismo. Nefrologia 2017; 37:441-443. [DOI: 10.1016/j.nefro.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 11/18/2022] Open
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Queiroz IV, Queiroz SP, Medeiros R, Ribeiro RB, Crusoé-Rebello IM, Leão JC. Brown tumor of secondary hyperparathyroidism: surgical approach and clinical outcome. Oral Maxillofac Surg 2016; 20:435-439. [PMID: 27640197 DOI: 10.1007/s10006-016-0575-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/05/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Secondary hyperparathyroidism is a frequent complication of chronic renal failure. The brown tumor is an unusual presentation of fibrous osteitis that represents a serious complication of renal osteodystrophy, affecting predominantly the hands, feet, skull, and facial bones. CASE REPORT The aim of this paper is to describe the case of a 53-year-old female patient, with renal failure who has been on dialysis for 6 years and developed severe secondary hyperparathyroidism and brown tumor of the maxilla and mandible, confirmed by incisional biopsy. Parathyroidectomy was indicated as a result of rapid growth of the tumor and the maintenance of laboratory findings. Despite the normalization of serum parathyroid hormone and alkaline phosphatase, tumor regression was slow and patient's important functional and esthetic deficits persisted. Excision of the mandible tumor was conservative. Osteoplasty was recommended because during a 5-year follow-up there was regression of the lesion, decreased pain, bleeding, and tooth mobility.
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Affiliation(s)
| | | | - Rui Medeiros
- Federal University of Pernambuco, Recife, Brazil
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14
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An unusual presentation of primary hyperparathyroidism: multiple brown tumors and coexisting thyroid carcinoma. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Imaging findings of spinal brown tumors: a rare but important cause of pathologic fracture and spinal cord compression. Clin Imaging 2016; 40:865-9. [PMID: 27179153 DOI: 10.1016/j.clinimag.2015.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/22/2015] [Accepted: 06/01/2015] [Indexed: 11/22/2022]
Abstract
Brown tumors rarely develop in the spine, and neurological compromise is exceedingly uncommon. There is a growing body of literature describing brown tumors that involve the spine, but few emphasize the radiographic findings. In the present case, we illustrate the development and progression of biopsy-proven brown tumors leading to neurological compromise through radiographs, computed tomography, magnetic resonance, and nuclear imaging acquired over a 4-year span.
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16
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Basaran Y, Ince S, Alagoz E, Meric C, Taslipinar A. An unusual presentation of primary hyperparathyroidism: multiple brown tumors and coexisting thyroid carcinoma. Rev Esp Med Nucl Imagen Mol 2016; 35:321-4. [PMID: 27036887 DOI: 10.1016/j.remn.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/15/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
We present a patient with a complex clinical picture of primary hyperparathyroidism with multiple destructive skeletal lesions suspicious of bone metastases and concomitant multifocal papillary thyroid carcinoma with a metastatic central lymph node. He presented with progressively worsening right hip pain and restricted motion. Magnetic resonance imaging revealed multiple lytic lesions involving predominantly the right trochanter minor and the left inferior and posterior pubic rami. Biochemical tests were consistent with primary hyperparathyroidism. Neck ultrasound and parathyroid scintigraphy revealed a single parathyroid adenoma and a thyroid nodule, preoperative cytology of which confirmed papillary thyroid carcinoma, as did the final surgical specimen. Biochemical results, regarding hyperparathyroidism, declined to normal levels and his complaints gradually decreased after surgery. Postoperative whole body bone scintigraphy showed increased tracer uptakes at multiple sites, but they were proved to be metabolically inactive by fluorodeoxyglucose positron emission tomography/computed tomography.
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Affiliation(s)
- Y Basaran
- Gulhane Military Medical Academy and School of Medicine, Department of Endocrinology and Metabolism, Etlik, Ankara, Turkey
| | - S Ince
- Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine, Etlik, Ankara, Turkey
| | - E Alagoz
- Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine, Etlik, Ankara, Turkey.
| | - C Meric
- Gulhane Military Medical Academy and School of Medicine, Department of Endocrinology and Metabolism, Etlik, Ankara, Turkey
| | - A Taslipinar
- Gulhane Military Medical Academy and School of Medicine, Department of Endocrinology and Metabolism, Etlik, Ankara, Turkey
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18
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Arsalanizadeh B, Westacott R. Osteoclastomas ('brown tumours') and spinal cord compression: a review. Clin Kidney J 2015; 6:220-3. [PMID: 26019852 PMCID: PMC4432455 DOI: 10.1093/ckj/sft021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 02/14/2013] [Indexed: 01/08/2023] Open
Abstract
Brown tumours are an uncommon manifestation of primary and secondary hyperparathyroidism. There are numerous case reports of brown tumours arising in various parts of the skeleton. They can therefore present a wide range of clinical manifestations. A recent case highlighted the need for heightened awareness of the diagnosis and prompted a literature review.
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Affiliation(s)
| | - Rachel Westacott
- John Walls Renal Unit , University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
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Brown tumor of the cervical spines: a case report with literature review. Asian Spine J 2015; 9:110-20. [PMID: 25705344 PMCID: PMC4330206 DOI: 10.4184/asj.2015.9.1.110] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/28/2013] [Accepted: 01/08/2014] [Indexed: 11/17/2022] Open
Abstract
To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion.
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Abstract
STUDY DESIGN Retrospective case series and literature review. OBJECTIVE To describe our experience in diagnosis and management of patients with spine brown tumor (osteitis fibrosa cystica) as the initial manifestation of primary hyperparathyroidism and also to review the pertinent literature. SUMMARY OF BACKGROUND DATA The spine can be involved through reparative processes such as giant cell reparative granuloma and brown tumor, which lead to formation of lesions that can simulate tumors on neuroimaging. Brown tumor, an uncommon focal giant cell lesion, is a nonneoplastic and reactive process due to bone resorption and localized osseous lesion caused by primary or secondary hyperparathyroidism. METHODS Among the cases of spine giant cell lesions treated surgically by the authors (2000-2013), there were 4 cases of spine brown tumor in patients with primary hyperparathyroidism. Clinical, radiological, histopathologic, and surgical data of these 4 cases were collected, and the patients were followed from 5 to 7 years after the surgical intervention. RESULTS There were 2 male and 2 female patients with age range of 16 to 52 years. The lesions were located in cervical (1 case), thoracic (1 case), and lumbar (2 cases) spine regions. Clinical presentations included neck and low back pain, radicular pain, paraparesis, and sphincter dysfunction. Surgical removal of the spine lesions was achieved in all cases. Spine fusion and instrumentation was done in 3 cases. Parathyroidectomy was performed in all 4 cases. CONCLUSION Spine involvement with brown tumor in patients with primary hyperparathyroidism is rare and may be the first manifestation of hyperparathyroidism. Brown tumor should be differentiated from other giant cell lesions involving the spine. Long-term surgical outcome was satisfactory with no recurrence. LEVEL OF EVIDENCE 4.
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Tayfun H, Metin O, Hakan S, Zafer B, Vardar AF. Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature. Asian J Neurosurg 2014; 9:40-4. [PMID: 24891890 PMCID: PMC4038866 DOI: 10.4103/1793-5482.131074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Brown tumor (BT), also known as osteoclastoma, may appear in the context of primary and secondary hyperparathyroidism. Spinal cord compression due to the BT is extremely rare. We present here an unusual case of BT involving thoracal spine and mandible. A 26-year-old woman, who had been on hemodialysis for chronic renal failure for over 6 years, got admitted with dorsal pain and progressive weakness in her lower extremities and gait disturbances. Neurological examination revealed spastic paraparesis and symmetrically hyperactive tendon reflex in the lower extremities. She had hypoesthesia under T10 level. On physical examination, a swelling on the left side of her jaw was also detected. Magnetic resonance imaging (MRI) showed cord compression due to an extradural mass lesion at T8 level. A computerized tomography (CT) scan showed that this expansile lytic lesion was caused by the collapse of vertebra corpus (T8) at that level. CT of the mandible revealed an expansile lytic lesion on left arm of the mandible. Laboratory findings were nearly normal except parathormone level elevation to 1289 pg/mL (normal 30-70 pg/mL). Ultrasound examination showed enlargement of the parathyroid glands. The patient underwent an emergency decompression and stabilization surgery. The lesion was fragile and reddish in appearance and was easy to aspirate. The tumor was reported as "BT." Her weakness in the lower extremities improved in the early postoperative period. Following surgical intervention, the patient was transferred to nephrology clinic for additional medical treatment.
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Affiliation(s)
- Hakan Tayfun
- Haydarpaşa Numune Teaching and Research Hospital, Neurosurgery Clinic, İstanbul, Turkey
| | - Orakdöğen Metin
- Haydarpaşa Numune Teaching and Research Hospital, Neurosurgery Clinic, İstanbul, Turkey
| | - Somay Hakan
- Haydarpaşa Numune Teaching and Research Hospital, Neurosurgery Clinic, İstanbul, Turkey
| | - Berkman Zafer
- Haydarpaşa Numune Teaching and Research Hospital, Neurosurgery Clinic, İstanbul, Turkey
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Karagoz A, Turkmen K, Yazici R, Arslan S, Baktık S, Karanis MIE, Altintepe L, Guney I. An exceedingly rare localization of a brown tumor in a hemodialysis patient. Hemodial Int 2012; 17:660-3. [PMID: 23216908 DOI: 10.1111/hdi.12002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Brown tumor, which is seen in the context of hyperparathyroidism, is defined as a uremic bone disease characterized by increased osteoclastic activity and fibroblastic proliferation in the involved bone. In chronic renal failure, there is an excessive parathyroid hormone secretion due to hypocalcemia, hyperphosphatemia, and vitamin D deficiency. Brown tumor of the femur, facial bones, mandible, sternum, ribs, and pelvis are rare, whereas, it rarely involves sacrum. Here, we presented a brown tumor of the sacrum that developed secondary to parathyroid hyperplasia in a patient receiving hemodialysis.
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Affiliation(s)
- Ali Karagoz
- Department of Nephrology, Meram Training and Research Hospital, Konya, Turkey
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Sunder S, Verma H, Venkataramanan K. Cervical tumoral calcinosis with secondary hyperparathyroidism in a chronic hemodialysis patient. Hemodial Int 2012; 17:458-62. [PMID: 23072397 DOI: 10.1111/j.1542-4758.2012.00760.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tumoral calcinosis is an uncommon and severe complication of chronic renal failure. It is generally associated with the presence of a high-serum calcium-and-phosphorus product. We report here a case of a patient on maintenance hemodialysis who presented with progressively increasing, solitary, tumor-like swelling over the nape of the neck. A 50-year-old female on thrice weekly maintenance hemodialysis for the last 3 years presented with a small swelling over the nape of the neck that had been progressively increasing over the last 1 year to cricket ball size. The patient was investigated and diagnosed as having tumoral calcinosis. The metastatic calcification occurring in the patient was most likely related to high calcium × phosphate product with coexistent secondary hyperparathyroidism possibly aggravated by vitamin D therapy. The patient was treated with withdrawal of vitamin D therapy, strict control of serum phosphate levels with noncalcemic phosphate binders, and subtotal parathyroidectomy. The neck swelling started decreasing in size after 2 months of parathyroidectomy and there was marked clinical improvement with drop in serum parathormone levels, over a period of 6 months. After 2 years of parathyroidectomy, the neck swelling again started increasing in size with increase in serum parathormone levels. The patient was treated with cinacalcet and the neck swelling gradually decreased in size along with control of serum parathormone and phosphate levels.
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Affiliation(s)
- Sham Sunder
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
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Uremic tumoral calcinosis causing atlantoaxial subluxation and spinal cord compression in a patient on continuous ambulatory peritoneal dialysis. Int Urol Nephrol 2012; 45:1511-6. [PMID: 22718028 DOI: 10.1007/s11255-012-0215-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 05/28/2012] [Indexed: 10/28/2022]
Abstract
Uremic tumoral calcinosis (UTC) is a form of metastatic tissue calcification unique to dialysis patients, manifesting with amorphous and cystic masses containing calcium phosphate deposits in periarticular soft tissue. An involvement of the cervical spine with bone destruction is extremely rare in UTC. We describe a 44-year-old uremic female on long-term continuous ambulatory peritoneal dialysis who developed UTC in the peri-odontoid region with consequent atlantoaxial subluxation and spinal cord compression, featuring severe neck soreness, headache, and hypertension. Surgical removal of the destructive cervical spine lesion, showing typical tumoral calcinosis on histology, completely resolved the clinical symptoms. To date, the patient maintains uneventful postoperative course with tight control of serum phosphorus, calcium, and secondary hyperparathyroidism by medical treatment. We also review other reported unusual cases of UTC involving the cervical spine and discuss the differential diagnosis of destructive spinal lesions in uremic patients, such as UTC, dialysis-related amyloidosis, and brown tumors.
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Déformation du massif facial chez une hémodialysée. Nephrol Ther 2012; 8:54-5. [DOI: 10.1016/j.nephro.2011.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/19/2011] [Accepted: 09/19/2011] [Indexed: 11/21/2022]
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