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Alrotoie AM, Aljohani AA, Alrehaili R, Alharbi M, Alalawi YM. Osteolytic Lesions (Brown Tumors) of Primary Hyperparathyroidism: A Report of Two Cases. Cureus 2024; 16:e61708. [PMID: 38975429 PMCID: PMC11225032 DOI: 10.7759/cureus.61708] [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: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Primary hyperparathyroidism is characterized by excessive production of parathyroid hormone. As the condition progresses, bone loss primarily occurs due to resorption. A complication of this condition is the formation of fibrotic and cystic changes in the bone, known as brown tumors. These lesions occur in areas of significant bone resorption, where fibrovascular tissue and giant cells replace bone tissue, often accompanied by hemorrhage and hemosiderin deposits. These brown lesions are rare, with an occurrence rate ranging from 1.5% to 4.5%. We present two cases of middle-aged women who had presentations consistent with hyperparathyroidism and presented with complications such as bone pain and numbness. Both underwent parathyroidectomy to manage the cause and recovered after the surgery. These cases emphasize the importance of recognizing primary hyperparathyroidism as a potential cause of abnormal lesions and highlight the diverse presentations associated with this condition.
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Affiliation(s)
| | | | | | | | - Yousef M Alalawi
- Endocrinology, Diabetes and Metabolism, Prince Mohammed Bin Abdulaziz Hospital, Medina, SAU
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2
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Majic Tengg A, Cigrovski Berkovic M, Zajc I, Salaric I, Müller D, Markota I. Expect the unexpected: Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism. World J Clin Cases 2024; 12:1200-1204. [PMID: 38524508 PMCID: PMC10955545 DOI: 10.12998/wjcc.v12.i7.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/10/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024] Open
Abstract
Hyperparathyroidism (HPT) is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone (PTH), causing disturbances in calcium homeostasis. Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia. Brown tumors are rare, benign, tumor-like bone lesions, occurring in 1.5% to 4.5% of patients with HPT, as a complication of an uncontrolled disease pathway, and are nowadays rarely seen in clinical practice. The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass. Furthermore, it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion. The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium, phosphorus, and PTH. Although when present, brown tumor is quite pathognomonic for HPT, the histologic finding often suggests a giant cell tumor, while clinical presentation might suggest other more frequent pathologies such as metastatic tumors. Treatment of brown tumors frequently focuses on managing the underlying HPT, which can often lead to regression and resolution of the lesion, without the need for surgical intervention. However, in refractory cases or when dealing with large symptomatic lesions, surgical treatment may be necessary.
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Affiliation(s)
- Ana Majic Tengg
- Department of Endocrinology, Diabetes, Metabolic Diseases and Clinical Pharmacology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
| | - Maja Cigrovski Berkovic
- Department for Sport and Exercise Medicine, Faculty of Kinesiology University of Zagreb, Zagreb 10000, Croatia
| | - Ivan Zajc
- Department of Oral Surgery, Clinical Hospital Dubrava, Zagreb 10000, Croatia
- University of Zagreb School of Dental Medicine, Zagreb 10000, Croatia
| | - Ivan Salaric
- Department of Oral Surgery, Clinical Hospital Dubrava, Zagreb 10000, Croatia
- University of Zagreb School of Dental Medicine, Zagreb 10000, Croatia
| | - Danko Müller
- Clinical Department of Pathology and Cytology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
| | - Iva Markota
- Clinical Department of Pathology and Cytology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
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3
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Pawar A, Rathod P, Aaron J, Bande V, Kapur K. Large Brown Tumour of Mandible with Bleeding as Initial Presentation: A Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:3988-3992. [PMID: 37974669 PMCID: PMC10646025 DOI: 10.1007/s12070-023-04003-w] [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: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 11/19/2023] Open
Abstract
Brown Tumour or Osteitis fibrous cystic or Von-Recklinghausen disease of bone is a non-malignant condition due to abnormal metabolism of bones in hyperparathyroidism. Although pathognomonic of hyperparathyroidism, brown tumours are rare and only case reports are found in literature. We report a case of brown tumour of mandible with recurrent episodes of bleeding. A 46 year old male patient presented in emergency with bleeding from ulceroproliferative mass from left floor of mouth. After control of bleeding, radiological, laboratory and histopathological investigations were done that led to the diagnosis of brown tumour of mandible in the presence of parathyroid adenoma of left lower parathyroid gland. Left upper and lower parthyroidectomy was done with segmental resection of mandible with mass and titanium plating. Brown tumour of facial bones is a rare entity. Very rarely it can reach enormous sizes to cause bleeding. Although parathyroidectomy and correction of parathormone levels cause regression of small tumours, large brown tumours with complications should be managed with surgical resection and reconstruction.
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Affiliation(s)
- Ajinkya Pawar
- Mch Surgical oncology, GCRI hospital, Ahmedabad, MS General surgery, DNB General surgery, 80B/42, Brindavan Society, Thane West, Maharashtra, 400601 India
| | - Priyank Rathod
- Surgical oncology, GCRI hospital, Ahmedabad, MS Mch Head and Neck oncosurgery, 1, Krushnapark Society, Karelibaig,, Vadodara, Gujarat 390018 India
| | - Jebin Aaron
- Mch Surgical oncology, GCRI hospital, Ahmedabad, MS General surgery, No 67 Moses St iyappa nagar pammal, Chennai, Tamil nadu 600075 India
| | - Vivek Bande
- Mch Surgical oncology, GCRI hospital, Ahmedabad, DNB General surgery, E 502, Neelkanth Park 1, Ghoda camp road, Shahibaug, Ahmedabad, Gujarat 380004 India
| | - Kanika Kapur
- Mch Surgical oncology, GCRI hospital, Ahmedabad, MS General surgery, House no 301, Aulyam-3, Meghaninagar, Ahmedabad, Gujarat 380016 India
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4
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Miwa S, Tanaka T, Aiba H, Yamada S, Otsuka T, Tsuchiya H. Multiple Bone Cysts Caused by Hyperparathyroidism: A Case Report and Review of the Literature. CANCER DIAGNOSIS & PROGNOSIS 2023; 3:590-596. [PMID: 37671306 PMCID: PMC10475927 DOI: 10.21873/cdp.10259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/13/2023] [Indexed: 09/07/2023]
Abstract
Background Brown tumor, a skeletal complication of severe hyperparathyroidism, comprises reparative granulation tissue and proliferating fibrous tissue with hemosiderin deposition. Multiple brown tumors are extremely rare complications of primary hyperparathyroidism. Case Report A 41-year-old woman presented with pain in the left knee. Radiography showed multiple cystic lesions in both femurs and the left proximal tibia, and additional radiography showed multiple cystic lesions in the left humerus and ulna. Magnetic resonance imaging (MRI) revealed multiple cystic lesions in the bilateral femurs, left proximal tibia, and ilium. Laboratory tests revealed hypercalcemia (albumin-corrected calcium level, 13.9 mg/dl), hypophosphatemia (phosphate level, 1.6 mg/dl), elevated level of alkaline phosphatase level (614 U/l), and markedly elevated parathyroid hormone (PTH) level (1,070 pg/ml; normal range=10-65 ng/l). 99mTc-hexakis-2-methoxyisobutyl-isonitrile scintigraphy revealed tracer accumulation in the left upper parathyroid gland, which was consistent with parathyroid tumor. Although resection of the parathyroid tumor was planned, the patient developed parathyroid apoplexy before tumor excision. After the parathyroid apoplexy, serum calcium and PTH levels temporarily normalized. Resurgence of the PTH level was observed 2 years after the diagnosis, and the patient underwent left upper parathyroidectomy. One year after the tumor excision, the patient had no symptoms, and MRI showed shrinkage of the cystic bone lesions. Conclusion This report emphasizes the importance of considering hyperparathy-roidism as a differential diagnosis for patients with multiple bone lesions.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tomohiro Tanaka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hisaki Aiba
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Yamada
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takanobu Otsuka
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Cho-Fon C, Ngokwe ZB, Ines ON. A Rare Presentation of a Bi-Maxillary Brown Tumour due to Secondary Hyperparathyroidism. Case Rep Dent 2023; 2023:6180006. [PMID: 37021075 PMCID: PMC10070017 DOI: 10.1155/2023/6180006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/30/2023] Open
Abstract
Brown tumours are localized bone lesions, seen in patients with high parathyroid hormone levels. This can be due to primary hyperparathyroidism, which occurs more often in neoplasms of the parathyroid gland or due to secondary hyperparathyroidism more often seen as a result of renal impairment. Facial involvement is rare, with most reports focusing on long and axial bones. However, the mandibular bone is often the only bone affected. Here, we report a rare case of a bi-maxillary attainment of brown tumour in a patient with secondary hyperparathyroidism due to chronic kidney disease.
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Tbini M, Essefi E, Kamel HE, Riahi I, Ben Salah M. Palatal swelling revealing a secondary hyperparathyroidism: A case report. Int J Surg Case Rep 2023; 103:107899. [PMID: 36652818 PMCID: PMC9860407 DOI: 10.1016/j.ijscr.2023.107899] [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: 12/08/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Secondary hyperparathyroidism is a common complication of chronic renal disease. Brown tumors are rare benign bone tumors caused by exposure to excessive parathyroid hormone secretion during hyperparathyroidism. Head and neck brown tumors are rare. Brown tumors regress spontaneously, completely or at least partially after parathyroidectomy.
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Affiliation(s)
- Makram Tbini
- ENT Department, Charles Nicolle Hospital, Boulevard du 9-Avril 1938, 1006 Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia.
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Yamauchi R, Ohshika S, Ono H, Saruga T, Ogawa T, Ishibashi Y. Diagnosis and Treatment of Brown Tumor in the Femur Induced by Parathyroid Carcinoma: A Case Report. Case Rep Oncol 2022; 15:1074-1080. [PMID: 36605224 PMCID: PMC9808300 DOI: 10.1159/000527637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022] Open
Abstract
Brown tumors are rare destructive bone lesions caused by hyperparathyroidism. As their clinical symptoms, radiographic findings, and laboratory results closely mimic those of metastatic tumors or multiple myeloma, the diagnosis may often be mistaken. We report a case of a 61-year-old woman with brown tumors in both femurs due to parathyroid carcinoma. The patient presented with multiple osteolytic lesions that caused pain in the right thigh. Whole-body computed tomography (CT), including the neck, suspected a parathyroid tumor, and a biopsy of the bone lesion revealed no malignancy. Following parathyroidectomy, she was diagnosed with a brown tumor with hyperparathyroidism due to a very rare parathyroid carcinoma. Although the right femoral lesion was indicated as an impending fracture, conservative treatment was performed because of the instability of her general condition after parathyroidectomy and her wishes. Bone remodeling of the right femur progressed, and the patient was ambulatory; however, 9 months postoperatively, the patient fell, developed a pathological fracture, and underwent internal fixation. When multiple osteolytic bone lesions are present, CT imaging of the neck should be performed to determine the possibility of a brown tumor due to parathyroid disease. Bone lesions of brown tumors are known to be naturally cured after treatment for hyperparathyroidism. However, when the lesion of a brown tumor in the femur is an impending fracture, prophylactic internal fixation is recommended aggressively if the patient's general condition permits.
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Affiliation(s)
- Ryota Yamauchi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shusa Ohshika
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroya Ono
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tasturo Saruga
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Testuya Ogawa
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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8
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Lim Y, Ball TA, Chin WW. Pathological ankle fracture due to brown tumour: atypical presentation of low serum vitamin D with normal parathyroid hormone and bone profile. BMJ Case Rep 2022; 15:e251726. [PMID: 36351671 PMCID: PMC9644310 DOI: 10.1136/bcr-2022-251726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Osteoclastomas or brown tumours are named as such due to increased vascularity, subsequent haemorrhage and haemosiderin deposition giving the lesion a reddish brown appearance under gross microscopic examination. It is due to an increase in parathyroid hormone activity from several causes, such as parathyroid adenomas, renal impairment and low vitamin D levels. The lesions increase the tendency of the bone to fracture. The challenging aspect of the diagnosis is that a histological diagnosis without immunohistochemistry is impossible to make. This is because, without special staining, brown tumours cannot be differentiated from giant cell tumours, which are also classed as benign but can be locally destructive and has potential for malignant transformation. Once tissue diagnosis is confirmed as a brown tumour, then aggressive forms of treatment are not needed, and they generally resolve once the underlying cause is treated. We describe a woman in her 80s who presented to the local Orthopaedic service with a pathological ankle fracture due to a brown tumour.
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Affiliation(s)
- Yizhe Lim
- Trauma and Orthopaedics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Wen Wei Chin
- Histopathology, University College Hospital, London, UK
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9
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Zhou Z, Shi Y, Li C, Wang W. Primary hyperparathyroidism-induced brown tumors caused by parathyroid carcinoma: a case report and literature review. J Int Med Res 2022. [PMCID: PMC9478702 DOI: 10.1177/03000605221123668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Brown tumors represent a benign disease that is induced by primary or secondary
hyperparathyroidism, with the pathological feature of osteitis fibrosa cystica. Primary
hyperparathyroidism caused by parathyroid carcinoma resulting in brown tumors is extremely
rare. Herein, we report the case of a 60-year-old male patient who was admitted for giant
cell tumors of the bone with local pain and limited movement of the left knee joint. With
early detection of multifocal osteolytic bone lesions, hyperparathyroidism (parathyroid
hormone: 2365.00 pg/mL), and parathyroid cancer, the diagnosis of brown tumors was
confirmed without any unnecessary or harmful interventions. Thereafter, he underwent
parathyroidectomy, from which postoperative pathology confirmed parathyroid carcinoma, and
total knee arthroplasty to restore movement of the knee joint. Seven months after surgery,
the left knee joint had good range of movement. This case emphasizes that detecting
patients’ parathyroid hormone levels should not be neglected when diagnosing multifocal
osteolytic bone lesions. A comprehensive analysis combining clinical symptoms, imaging,
and laboratory tests is conducive to accurate disease assessments and avoiding unnecessary
or even survival-impairing surgery. However, when the tumor involves a large joint or
seriously affects joint movement, surgery may be worth considering.
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Affiliation(s)
- Zhongkai Zhou
- Department of Magnetic Resonance, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ying Shi
- Department of Magnetic Resonance, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Chao Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wei Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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10
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Zhong Y, Huang Y, Luo J, Ye Y. Misdiagnosis of brown tumour caused by primary hyperparathyroidism: a case report with literature review. BMC Endocr Disord 2022; 22:66. [PMID: 35287634 PMCID: PMC8919606 DOI: 10.1186/s12902-022-00971-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Brown tumour is a rare tumour-like lesion of the bone, which is considered as an end-stage lesion of abnormal bone metabolism caused by persistently high parathyroid hormone (PTH) levels. Brown tumour can be found in any part of the skeleton; in some cases, it can occur in multiple bones and can be easily misdiagnosed as a metastatic tumour. CASE PRESENTATION We report the case of a 44-year-old man who presented to the Department of Oncology in our hospital with a 2-month history of local pain in his left shoulder joint. The initial diagnosis was an aneurysmal bone cyst by biopsy, for which the patient underwent tumour resection surgery. The diagnosis of a malignant tumour was made again following postoperative pathological examination. The pathological sections and all clinical data were sent to the Department of Pathology of the First Affiliated Hospital of Sun Yat-sen University; the diagnosis made there was brown tumour. His blood PTH level was 577 pg/ml (15-65 pg/ml). Colour Doppler ultrasonography of the parathyroid gland suggested a parathyroid adenoma. For further treatment, the left parathyroid adenoma was removed by axillary endoscopic resection. Postoperatively, a pathologic examination was performed, and the diagnosis of a parathyroid adenoma was confirmed. One year after the surgery, the left humerus was completely healed, and the left shoulder joint had a good range of movement. CONCLUSIONS In summary, histopathological diagnosis is not sufficient for the diagnosis of brown tumours. A comprehensive analysis combining clinical symptoms with findings of imaging and laboratory tests is also required. Generally, the treatment of brown tumour includes only partial or complete resection of the parathyroid glands. However, when the tumour is large, especially when it involves the joint, surgery is indispensable.
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Affiliation(s)
- Yanchun Zhong
- Department of spine surgery, First Affiliated Hospital of Gannan Medical University, No. 128 Jin Ling Road, 341000, Ganzhou, Jiangxi, China
| | - Yuxi Huang
- Department of basic medicine, Gannan Health Vocational College, No. 12 Rong Jiang Road, 341000, Ganzhou, Jiangxi, China
| | - Jiaquan Luo
- Department of spine surgery, First Affiliated Hospital of Gannan Medical University, No. 128 Jin Ling Road, 341000, Ganzhou, Jiangxi, China
| | - Yongjun Ye
- Department of spine surgery, First Affiliated Hospital of Gannan Medical University, No. 128 Jin Ling Road, 341000, Ganzhou, Jiangxi, China.
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11
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Shum BJ, Kim MS, Kondra K, Hammoudeh JA, Strom C, Ryabets-Lienhard A. A Unique Case of Aggressive Central Giant Cell Granuloma in a 10-Year-Old Boy With 16p13.11 Microdeletion Syndrome. J Investig Med High Impact Case Rep 2022; 10:23247096221123146. [PMID: 36154495 PMCID: PMC9513564 DOI: 10.1177/23247096221123146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Central giant cell granuloma (CGCG) is a rare disease characterized by
sporadic, benign, intraosseous mandibular lesions of unknown etiology.
Histologically, these lesions are indistinguishable from brown tumors
of hyperparathyroidism and cherubism, and occasionally have been
associated with different syndromes raising a question for genetic
etiology. The CGCG has varied presentation ranging from nonaggressive
and indolent to aggressive, destructive, and recurrent, often posing
diagnostic and therapeutic challenges. Herein, we present the first
case of a 10-year-old boy with CGCG and 16p13.11 microdeletion
syndrome, highlight the diagnostic challenges inherent to this
heterogeneous disorder, and discuss the genetics and treatment
approaches of these complex lesions.
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Affiliation(s)
- Betty J. Shum
- Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, CA, USA
| | - Mimi S. Kim
- Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, CA, USA
- The Saban Research Institute at Children’s Hospital Los Angeles, CA, USA
- University of Southern California, Los Angeles, USA
| | - Katelyn Kondra
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, CA, USA
| | - Jeffrey A. Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, CA, USA
| | - Charles Strom
- Department of Medical Genetics, Children’s Hospital Los Angeles, CA, USA
| | - Anna Ryabets-Lienhard
- Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, CA, USA
- The Saban Research Institute at Children’s Hospital Los Angeles, CA, USA
- University of Southern California, Los Angeles, USA
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Carpenter TO, Kelly HR, Sherwood JS, Peacock ZS, Nosé V. Case 32-2021: A 14-Year-Old Girl with Swelling of the Jaw and Hypercalcemia. N Engl J Med 2021; 385:1604-1613. [PMID: 34670047 DOI: 10.1056/nejmcpc2107351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Thomas O Carpenter
- From the Department of Pediatrics (Endocrinology Section), Yale University School of Medicine, New Haven, CT (T.O.C.); and the Departments of Radiology (H.R.K.), Pediatrics (J.S.S.), Oral and Maxillofacial Surgery (Z.S.P.), and Pathology (V.N.), Massachusetts General Hospital, the Department of Radiology (H.R.K.), Massachusetts Eye and Ear, and the Departments of Radiology (H.R.K.), Pediatrics (J.S.S.), Oral and Maxillofacial Surgery (Z.S.P.), and Pathology (V.N.), Harvard Medical School - all in Boston
| | - Hillary R Kelly
- From the Department of Pediatrics (Endocrinology Section), Yale University School of Medicine, New Haven, CT (T.O.C.); and the Departments of Radiology (H.R.K.), Pediatrics (J.S.S.), Oral and Maxillofacial Surgery (Z.S.P.), and Pathology (V.N.), Massachusetts General Hospital, the Department of Radiology (H.R.K.), Massachusetts Eye and Ear, and the Departments of Radiology (H.R.K.), Pediatrics (J.S.S.), Oral and Maxillofacial Surgery (Z.S.P.), and Pathology (V.N.), Harvard Medical School - all in Boston
| | - Jordan S Sherwood
- From the Department of Pediatrics (Endocrinology Section), Yale University School of Medicine, New Haven, CT (T.O.C.); and the Departments of Radiology (H.R.K.), Pediatrics (J.S.S.), Oral and Maxillofacial Surgery (Z.S.P.), and Pathology (V.N.), Massachusetts General Hospital, the Department of Radiology (H.R.K.), Massachusetts Eye and Ear, and the Departments of Radiology (H.R.K.), Pediatrics (J.S.S.), Oral and Maxillofacial Surgery (Z.S.P.), and Pathology (V.N.), Harvard Medical School - all in Boston
| | - Zachary S Peacock
- From the Department of Pediatrics (Endocrinology Section), Yale University School of Medicine, New Haven, CT (T.O.C.); and the Departments of Radiology (H.R.K.), Pediatrics (J.S.S.), Oral and Maxillofacial Surgery (Z.S.P.), and Pathology (V.N.), Massachusetts General Hospital, the Department of Radiology (H.R.K.), Massachusetts Eye and Ear, and the Departments of Radiology (H.R.K.), Pediatrics (J.S.S.), Oral and Maxillofacial Surgery (Z.S.P.), and Pathology (V.N.), Harvard Medical School - all in Boston
| | - Vania Nosé
- From the Department of Pediatrics (Endocrinology Section), Yale University School of Medicine, New Haven, CT (T.O.C.); and the Departments of Radiology (H.R.K.), Pediatrics (J.S.S.), Oral and Maxillofacial Surgery (Z.S.P.), and Pathology (V.N.), Massachusetts General Hospital, the Department of Radiology (H.R.K.), Massachusetts Eye and Ear, and the Departments of Radiology (H.R.K.), Pediatrics (J.S.S.), Oral and Maxillofacial Surgery (Z.S.P.), and Pathology (V.N.), Harvard Medical School - all in Boston
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13
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Santhanam S, Chandrasekaran S. Multifocal Brown Tumor: A Case of Primary Hyperparathyroidism. J Clin Rheumatol 2021; 27:e166-e167. [PMID: 31977659 DOI: 10.1097/rhu.0000000000001306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Shavlokhova V, Goeppert B, Gaida MM, Saravi B, Weichel F, Vollmer A, Vollmer M, Freudlsperger C, Mertens C, Hoffmann J. Mandibular Brown Tumor as a Result of Secondary Hyperparathyroidism: A Case Report with 5 Years Follow-Up and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147370. [PMID: 34299820 PMCID: PMC8304219 DOI: 10.3390/ijerph18147370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 12/02/2022]
Abstract
Background: Brown tumor is a rare skeletal manifestation of secondary hyperparathyroidism. Although diagnosis of the disease is increasingly seen in early stages due to improved screening techniques, some patients still present in a progressed disease stage. The treatment depends on tumor mass and varies from a conservative approach with supportive parathyroidectomy to extensive surgical resection with subsequent reconstruction. Case presentation: We report a case of extensive mandibular brown tumor in a patient with a history of systemic lupus erythematosus, chronic kidney disease, and secondary hyperparathyroidism. Following radical resection of the affected bone, reconstruction could be successfully performed using a free flap. Conclusions: There were no signs of recurrence during five years of close follow-up. Increased awareness and multidisciplinary follow-ups could allow early diagnosis and prevent the need for radical therapeutical approaches.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
- Correspondence:
| | - Benjamin Goeppert
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (B.G.); (M.M.G.)
| | - Matthias M. Gaida
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (B.G.); (M.M.G.)
- Institute of Pathology, University Medical Center Mainz, Johannes Gutenberg-Universität Mainz, 55131 Mainz, Germany
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany;
| | - Frederic Weichel
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Andreas Vollmer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Michael Vollmer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Christian Mertens
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Jürgen Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
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15
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Tiong MK, Yates CJ, Toussaint ND. Muddying the waters of hyperparathyroidism management in chronic kidney disease: a brown tumour in a predialysis patient. Intern Med J 2021; 51:450-451. [PMID: 33738939 DOI: 10.1111/imj.15235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mark K Tiong
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher J Yates
- Department of Medicine (RMH), University of Melbourne, Melbourne, Victoria, Australia.,Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Melbourne, Victoria, Australia
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16
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Ngo QX, Ngo DQ, Tran TD, Le DT, Hoang GN, Le QV. Multiple brown tumors with primary hyperparathyroidism mimicking bone metastases []. Int J Surg Case Rep 2021; 79:375-378. [PMID: 33516054 PMCID: PMC7847817 DOI: 10.1016/j.ijscr.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/31/2020] [Accepted: 01/01/2021] [Indexed: 11/25/2022] Open
Abstract
Brown tumor is the differential diagnosis with bone metastasis. Brown tumor is a rare benign lesions in skeletal system, which caused by uncontrolled primary or secondary hyperparathyroidism. Serum phosphate, serum calcium and PTH level measurements are helpful diagnostic tools.
Multiple osteolytic lesions are usually associated with bone metastasis. However, brown tumor should also be included in the differential diagnosis. Brown tumor is a rare benign lesions in skeletal system, encountered in patients with uncontrolled primary or secondary hyperparathyroidism. In our case report, we present a 35-year-old female with multifocal brown tumor that difficultiy in differential diagnosis of metastasis of malignant parathyroid. Additionally, the treatment and follow up after parathyroidectomy are also emphasized. Methods The SCARE 2020 Guideline [1].
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Affiliation(s)
- Quy X Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Hanoi, Viet Nam.
| | - Duy Q Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Hanoi, Viet Nam.
| | - Toan D Tran
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Hanoi, Viet Nam.
| | - Duong T Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Hanoi, Viet Nam.
| | - Giap N Hoang
- Hanoi Medical University, 01 Ton That Tung Street, Dong Da District, Hanoi, Viet Nam.
| | - Quang V Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Hanoi, Viet Nam; Hanoi Medical University, 01 Ton That Tung Street, Dong Da District, Hanoi, Viet Nam.
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17
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Maalouly C, Vô B, Labriola L. Back Pain and Lower Extremity Sensory Loss in an ESKD Patient. KIDNEY360 2020; 1:1466-1467. [PMID: 35372886 PMCID: PMC8815532 DOI: 10.34067/kid.0003322020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/30/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Christian Maalouly
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Bernard Vô
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laura Labriola
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
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18
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Bransky N, Iyer NR, Cannon SM, Tyan AH, Mylavarapu P, Orosco R, Hom DB, Moazzam AA. Three Rare Concurrent Complications of Tertiary Hyperparathyroidism: Maxillary Brown Tumor, Uremic Leontiasis Ossea, and Hungry Bone Syndrome. J Bone Metab 2020; 27:217-226. [PMID: 32911586 PMCID: PMC7571245 DOI: 10.11005/jbm.2020.27.3.217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/02/2020] [Indexed: 12/27/2022] Open
Abstract
A 48-year-old woman in her 40’s with end-stage renal disease and tertiary hyperparathyroidism (HPT) presented for a rapidly progressive maxillary tumor. Initial workup was notable for elevated intact parathyroid hormone (PTH) and diffuse thickening of skull and facial bones on computed tomography, and maxillary tumor biopsy with multinucleated giant cells. She underwent subtotal parathyroidectomy (with removal of a parathyroid adenoma and 2 hyperplastic glands) and partial resection of maxillary brown tumor. The patient’s post-operative course was complicated by hungry bone syndrome, with hypocalcemia refractory to aggressive calcium repletion. Teriparatide (recombinant PTH) was utilized with rapid resolution of hypocalcemia. To our knowledge, this is the first case of maxillary brown tumor in tertiary HPT to be reported in the USA. This case also supports teriparatide as a novel therapeutic for hungry bone syndrome refractory to aggressive calcium repletion.
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Affiliation(s)
- Natalie Bransky
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - Neena Ramesh Iyer
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | | | | | - Praneet Mylavarapu
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - Ryan Orosco
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - David Brain Hom
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - Alan Ali Moazzam
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
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19
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Craniofacial Brown Tumor in Patients with Secondary Hyperparathyroidism to Chronic Renal Failure: Report of Two Cases in Cipto Mangunkusumo Hospital. Case Rep Oncol Med 2018; 2018:1801652. [PMID: 30298112 PMCID: PMC6157168 DOI: 10.1155/2018/1801652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/17/2018] [Accepted: 07/11/2018] [Indexed: 11/23/2022] Open
Abstract
Brown tumor is a bone lesion that arises in the setting of excess osteoclast activity in hyperparathyroidism. It consists of fibrous tissue, woven bone, and supporting vasculature, while contains no matrix. The characteristic of brown-colored lesion is a result of hemosiderin deposition into the osteolytic cysts. Two cases of young women aged 26 and 29 years old, respectively, are known with a history of end-stage renal disease (ESRD). Dialysis is performed two times/week over the last 7 years. Our patients presented with an intraoral mass of the hard palate since 12 months ago and decreased body height of 10 cm. The lesion causes difficulties in swallowing and talking. Laboratory workup showed elevated parathormone or PTH (3.391 pg/mL and >5.000 pg/mL). Neck ultrasound showed enlargement of the parathyroid glands. Supporting examination to diagnose brown tumor are neck ultrasound, CT of the neck, and parathyroid sestamibi scan. We performed parathyroidectomy. Pathology revealed hyperplasia of the parathyroid. The tumor regressed significantly within 2 weeks following the surgery, and we still observe tumor regression as well as reduction in PTH level. As clinicians, we should be alert to other possible causes of bony lesions. Clinical examination, laboratory finding, and imaging present important information to diagnose brown tumor.
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20
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Parihar AS, Bhadada S, Bhattacharya A, Mittal BR. Facial Dysmorphism Due to Multiple Brown Tumors Secondary to Large Parathyroid Adenoma, Diagnosed on 99mTc-Sestamibi Parathyroid Scintigraphy. INDIAN JOURNAL OF NUCLEAR MEDICINE : IJNM : THE OFFICIAL JOURNAL OF THE SOCIETY OF NUCLEAR MEDICINE, INDIA 2018; 33:255-256. [PMID: 29962730 PMCID: PMC6011569 DOI: 10.4103/ijnm.ijnm_35_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Brown tumors are an uncommon entity associated with hyperparathyroidism. Initially described with primary hyperparathyroidism, with the widespread use of dialysis, they were also seen to be associated with secondary and tertiary hyperparathyroidism. These are lytic, expansile lesions causing bony pains, and depending on the size and extent, skeletal dysmorphism. The present case illustrates the detection of parathyroid adenoma with multiple brown tumors on 99mTc-sestamibi parathyroid scintigraphy in a patient presenting with facial dysmorphism and multiple bony pains.
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Affiliation(s)
- Ashwin Singh Parihar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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21
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Panagopoulos A, Tatani I, Kourea HP, Kokkalis ZT, Panagopoulos K, Megas P. Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna and radius: a case report. J Med Case Rep 2018; 12:176. [PMID: 29936913 PMCID: PMC6016128 DOI: 10.1186/s13256-018-1723-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Brown tumors represent a rare clinical manifestation reported in approximately 3% of patients with primary hyperparathyroidism and correspond to radiologically osteolytic lesions with well-defined borders in different parts of the skeleton. Case presentation We report the case of a 53-year-old white man who presented to our hospital with osteolytic lesions of his distal ulna and radius, causing pain and swelling of 2-month duration. A subsequent biopsy revealed histological features consistent with giant cell tumor and a complete resection of his distal ulna was followed, along with curettage and cementoplasty of the distal radial metaphysis. Two weeks later, he was re-admitted with diffuse musculoskeletal soreness, anorexia, constipation, nausea, and localized abdominal pain and multiple osteolytic lesions on plain radiographs. A histopathological examination of the ulna and radius specimens showed similar findings and, given the multifocality, brown tumors related to primary or secondary hyperparathyroidism was included in the differential diagnosis. A laboratory examination showed high total serum calcium (14.5 mg/dl) and low serum phosphorus and 25-hydroxyvitamin D levels. Primary hyperparathyroidism was suspected and confirmed by the elevated parathyroid hormone levels of 1453 pg/mL. At radiological work-up, using computed tomography, ultrasonography, and parathyroid subtraction technetium-99m sestamibi scintigraphy, a 4.5 × 2.5 × 3.2 cm mass emanating from the right lobe of his thyroid gland was detected, displaying extensive uptake in the right lower parathyroid gland. After appropriate medical support including hyperhydration and high doses of diuretics and diphosphonates, his laboratory profile normalized and he underwent total thyroidectomy with removal of the parathyroid glands. Our patient is now recovering 12 months after surgery, with normal values of serum parathyroid hormone and calcium levels. The lytic bone lesions have almost disappeared and no other additional orthopedic intervention was necessary. Conclusions The present case report emphasizes the need of inclusion of brown tumors in the differential diagnosis of multifocal osteolytic bone lesions, in order to avoid harmful surgical interventions. Laboratory testing of serum phosphate, calcium levels, and parathyroid hormone levels should always be included in the routine survey of patients with multifocal osteolytic lesions.
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Affiliation(s)
- A Panagopoulos
- Orthopaedic Department, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patras, Greece.
| | - I Tatani
- Orthopaedic Department, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patras, Greece
| | - H P Kourea
- Department of Pathology, Patras University Hospital, Rio-Patras, Greece
| | - Z T Kokkalis
- Orthopaedic Department, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patras, Greece
| | - K Panagopoulos
- Department of General Surgery, Patras University Hospital, Rio-Patras, Greece
| | - P Megas
- Orthopaedic Department, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patras, Greece
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Goyal A, Boro H, Khadgawat R. Brown Tumor as an Index Presentation of Severe Vitamin D Deficiency in a Teenage Girl. Cureus 2018; 10:e2722. [PMID: 30079288 PMCID: PMC6067807 DOI: 10.7759/cureus.2722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Brown tumor is a non-neoplastic fibro-cystic expansile bone lesion caused by parathyroid hormone excess. It has been commonly described in patients with primary hyperparathyroidism and secondary hyperparathyroidism due to chronic kidney disease. However, it is very rare to encounter a brown tumor in the setting of nutritional vitamin D deficiency. We describe the case of a 16-year-old girl who presented with brown tumor-like lytic lesion of femur caused by severe longstanding vitamin D deficiency. Treatment with elemental calcium and cholecalciferol resulted in correction of hyperparathyroid state, with the resultant disappearance of the bony lesion and remarkable symptomatic improvement. Unnecessary orthopaedic intervention may be avoided using a high index of suspicion and performing targeted investigations in such cases.
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Affiliation(s)
- Alpesh Goyal
- Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, IND
| | - Hiya Boro
- Endocrinology, All India Institute of Medical Sciences, New Delhi, IND
| | - Rajesh Khadgawat
- Endocrinology, All India Institute of Medical Sciences, New Delhi, IND
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23
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Singhal AA, Baijal SS, Sarin D, Pathak A. Unusually Large Brown tumor of Mandible in a Case of Secondary Hyperparathyroidism Mimicking Cherubism. Indian J Nucl Med 2018; 33:132-135. [PMID: 29643674 PMCID: PMC5883431 DOI: 10.4103/ijnm.ijnm_145_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report here a case of unusually large brown tumor of mandible mimicking cherubism in a patient with secondary hyperparathyroidism (HPT). The patient is a young male with a large head and a protruding jaw with an open mouth appearance. Initial clinical appearance looked like cherubism. However further clinical, biochemical, and radiological evaluation revealed a large brown tumor in a case of prolonged secondary HPT, which was confirmed on histopathology. All of the typical advanced radiological features of HPT were noted, highlighting the severity of progression of the disease. This case emphasizes the need for surveillance of serum calcium levels on routine biochemical investigations as to enable an early diagnosis of HPT. With timely proper management, such cases should be on the decline in the future.
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Affiliation(s)
- Alka Ashmita Singhal
- Medanta Division of Radiology and Nuclear Medicine, Medanta The Medicity Hospital, Gurugram, Delhi, NCR, India
| | - Sanjay Saran Baijal
- Medanta Division of Radiology and Nuclear Medicine, Medanta The Medicity Hospital, Gurugram, Delhi, NCR, India
| | - Deepak Sarin
- Medanta Division of Radiology and Nuclear Medicine, Medanta The Medicity Hospital, Gurugram, Delhi, NCR, India
| | - Atul Pathak
- Medanta Division of Radiology and Nuclear Medicine, Medanta The Medicity Hospital, Gurugram, Delhi, NCR, India
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Facial swelling in a child on chronic hemodialysis: Answers. Pediatr Nephrol 2017; 32:1351-1353. [PMID: 27858195 DOI: 10.1007/s00467-016-3525-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
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