Jarrar SM, Daoud SS, Jbarah OF, Albustami IS. Paraparesis As a Rare First Presentation Of Primary Hyperparathyroidism-Related Brown Tumor in The Thoracic Spine: Case report and literature review.
Ann Med Surg (Lond) 2021;
63:102197. [PMID:
33717480 PMCID:
PMC7933711 DOI:
10.1016/j.amsu.2021.102197]
[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: 01/28/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance
Brown tumor (BT) is defined as osteolytic lesion of an underlying state of hyperparathyroidism. Hyperparathyroidism will activate osteoclasts which initiate active bone resorption foci of lytic-cysts with hemosiderin depositions that pigment it with its characteristic brown pathologic gross appearance. Devastating fractures and injuries can occur to affected bones and surrounding tissue that require emergent intervention and correction.
Case presentation
We present a case of a medically free 31-year-old female patient, who presented complaining of unsteadiness and progressive lower limbs weakness over 40 days of duration. Subsequent lab tests showed elevated PTH levels, along with 3.5 × 1.8 cm heterogeneous soft tissue mass involving the right pedicle on T7 level compressing the corresponding level of the spinal cord. Surgical management aimed to decompress the spinal cord and to obtain a biopsy for histopathologic examination which revealed a brown tumor. Neck ultrasound and Sestamibi scan indicated the presence of hyperactive and hyperplastic parathyroid tissue most suggestive of parathyroid adenoma.
Clinical discussion
Various presentations of Brown Tumor depend on the bone affected, despite the rarity of spinal involvement, yet expanding tumors can manifest either with back pain, radicular pain, paresthesia, weakness, paralysis, or incontinence. The highest incidence rates of spinal brown tumors affect adults over the age of 40. Management goals are to decompress the neuronal tissue emergently and to prevent further bony lytic deterioration.
Conclusion
The objective of this study is to provide an overview of primary hyperparathyroidism-related spinal brown tumors, presentation, and summary of previously reported similar cases in the literature.
Brown tumors are rare manifestation of today's primary hyperparathyroidism clinical presentation and context when compared with secondary hyperparathyroidism.
Up to 3% of patients with primary hyperparathyroidism develops BTs, the incidence is furtherly declining due to screening and health assessment programs.
Brown tumors are destructive lesions that could be single or multiple at any site involving long bones, hands, mandible, pelvis and ribs, which are way more common sites than the spine.
Almost half of Primary Hyperparathyroidism-Related Brown Tumors of the spine were found to affect the thoracic region. While sacral region was least to be affected.
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