Brown tumors of hyperparathyroidism misdiagnosed as multifocal Giant Cell Tumors of bone: A case report (original) (raw)
Related papers
Journal of Medical Case Reports, 2018
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.
Primary Hyperparathyroidism With Brown Tumor Mimicking Metastatic Bone Malignancy
Journal of the Chinese Medical Association, 2010
Bone and joint pain are commonly encountered conditions in daily practice. In the elderly, when osteolytic lesions are identified in imaging studies, metastatic bone tumor is the first impression that comes to the clinician's mind. Although the worst-case scenario should be ruled in, other differential diagnoses such as metabolic bone disease should be considered as well. We report a case of brown tumor caused by parathyroid adenoma. The patient had initial presentation of diffuse bone pain and multiple osteolytic lesions on imaging studies similar to metastatic bone tumor. With a systematic approach and awareness of metabolic bone disease, an accurate diagnosis was finally reached. Appropriate treatments, including preventive internal fixation of the impending femoral fracture and surgical excision of the parathyroid adenoma were performed accordingly. The key treatment for the condition was surgical excision of the parathyroid adenoma. After normalization of serum intact-parathyroid hormone level, the bony lesions resolved and required no further orthopedic surgery. The patient is now symptom-free. In addition to suspecting malignancy, the clinician should be highly alert to other possible causes of bony lesions. Brown tumor should be kept in mind during daily practice. [J Chin Med Assoc 2010;73(3):177-180]
Brown tumors: an uncommon manifestation of bone disease in primary hyperparathyroidism
DOAJ (DOAJ: Directory of Open Access Journals), 2019
Bone involvement in primary hyperparathyroidism (PHPT) is characterized by decreased bone mineral density, bone resorption at both trabecular and cortical sites and bone erosions, up to brown tumors (BT) and cysts, the so-called osteitis fibrosa cystica (OFC). Signs and symptoms of OFC include bone pain, muscle weakness, skeletal deformities and pathological fractures. In recent years, PHPT has greatly changed its clinical expression, especially in Western countries. For these reason BT, a typical expression of OFC, are always less observed and often mistaken for malignancy. An integrated diagnostic approach, considering first a complete biochemical panel and a confirmation by functional imaging, is crucial for a correct diagnosis, mostly considering that such skeletal manifestations may be reversible after surgical cure of PHPT.
Diagnostic dilemma: metastatic bone malignancy or primary hyperparathyroidism with brown tumor
2013
Multiple osteolytic lesions are usually associated with metastatic involvement of the bone. However metabolic bone diseases should also take their place in differential diagnosis. Here, we describe a primary hyperparathyroidism case with full-blown osteolytic lesions wich was diagnosed at first sight with having metastatic bone involvement. PET CT scan and laboratory results excluded a metastatic bone malignancy. Elevated serum calcium of 13.16 mg/dl, decreased serum phoshorus of 1.4 mg/dl and high intact-PTH level of 1054.7 pg/ml pointed out primary hyperparathyroidism. Sonographic examination revealed two adenomas of 2.9 × 3.3 mm and 3.3 × 2.7 mm in the left superior and right inferior parathyroid glands, respectively. Scintigraphy confirmed the presence of adenoma on the left.
Multiple brown tumors with primary hyperparathyroidism mimicking bone metastases [ ]
International Journal of Surgery Case Reports, 2021
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].
Tertiary Hyperparathyroidism Inducing Brown Tumour: A Rare Case
2016
Brown tumours (BTs), also known as osteitis fibrosa cystica, are non-neoplastic giant cell lesions which appear in the advanced stage of hyperparathyroidism. Patients with giant cell lesions should be screened for serum calcium, parathyroid hormone (PTH) and alkaline phosphatase. The BT may affect any part of the skeleton but is frequently found in long bones, pelvic girdle, clavicle, ribs and the mandible. The authors present a rare case of BT in tertiary hyperparathyroidism (THP) involving bilateral maxilla, left maxillary sinus, lateral wall of the nose, floor of the orbit and bilateral mandible in a 28-year-old male patient.
Brown Tumor: Rare Skeletal Presentation Secondary to Hyperparathyroidism
Brown tumor is a giant cell lesion associated with hypepararthyroidism. It is a non-neoplastc condition and represents terminal stage of the remodeling process in hyperparathyroid state. This severe parathyroid bone disease is a rare clinical presentation of primary hyperparathyroidism which is due most often to a parathyroid adenoma, secreting parathormone(PTH). Elevated PTH levels cause bone resorption, the formation of polyostotic lesions and a reduction in bone mineral density, predisposing to pathological fractures. Here we report the case of young female having primary hyperthyroidism due to parathyroid adenoma with osteolytic cysic lesions at distal femur, distal end clavicle, iliac bone. She was treated with surgical excision of parathyroid with curettage, autogenous bone grafting, internal fixation with plate after confirming the biopsy report and biochemical, histopathological investigations. At the follow up time patient had no symptoms with full range of motions at knee with excellent fracture healing.
Medicinus
Brown tumor is a non-neoplastic lesion that resulting from abnormal bone metabolism. It can be manifest in prolonged or untreated hyperparathyroidism. The clinical symptoms, radiological and histopathological examination were similar with giant cell tumor and can be mimicking metastases; or even misdiagnosed with giant cell tumor and mistreated the patient. Biochemical examination of calcium levels and parathyroid hormone should be included in the routine assessment of patients with multiple osteolytic lesions. A multidiscipline approach is needed.Throughout this case report, we would like to report the important role of Nuclear Medicine and Molecular Theranostic imaging modality in 38-year-old male with multiple osteolytic lesions, which was first diagnosed as giant cell tumor and differential diagnosis bone metastases but turnout to be a metabolic bone disease (brown tumor) with parathyroid adenoma as etiology.
Tertiary hyperparathyroidism with multiple Brown tumors mimicking malignancy
Scholars Academic Journal of Biosciences, 2016
Brown tumors are an uncommon type of benign osteolytic bone lesions that occur in hyperparathyroidism, which is an endocrine disease characterized by excessive secretion of the hormone parathormone. They occur more in primary hyperparathyroidism and are seen to regress after removal of parathyroid adenomas. In our report, we describe a a case of tertiary hyperparathyroidism with multiple lytic lesions of the right great toe, left fibula, twelfth posterior rib on right side and base of middle phalanx of left hand. This report illustrates the importance of taking brown tumor in differential diagnosis in patients with multiple lytic lesions, occurring in the backdrop of chronic kidney disease, where a failure to establish an accurate diagnosis may lead to further unnecessary and painful diagnostic procedures and even extensive surgery.
Tertiary Hyperparathyroidism Presenting as Multifocal Brown Tumors: A Case Report
Journal Of Endocrinology And Metabolism Research, 2023
Brown Tumor (BT) of the bone is a rare manifestation of hyperparathyroidism (HPTH), an unusual reactive bone lesion attributed to disturbed bone remodeling, from long-standing increase in parathyroid hormone level (PTH). Historically, BTs were described with primary HPTH but due to early diagnosis of this entity, and improved survival in patients with end-stage renal disease (ESRD) especially those on renal replacement therapy (RRT), more cases of BT are now described in this population, and less in PHPTH. Thus, it is mostly the consequence of untreated secondary or tertiary HPTH whose major culprits are chronic kidney disease (CKD) and ESRD. The management of brown tumors related to chronic renal failure consists primarily of its prevention through the use of phosphate binders, vitamin D analogues, and calcimimetics with surgical parathyroidectomy reserved as the final resort in refractory cases. Herein, we present the case of a 24-year-old female patient with ESRD on intermittent hemodialysis (IHD) who developed recent onset facial tumefaction. Blood work revealed markedly elevated PTH at more than 5000 pg/ml, upper borderline hypercalcemia, and hyperphosphatemia. Further investigations with chest computed tomography (CT) and Technetium-99m (99mTc)- Sestamibi scan nuclear imaging showed multiple ribs lytic lesions as well as features of extensive BT and parathyroid adenomas. Thereafter, the patient was sent for parathyroidectomy after which the patient developed hungry bone syndrome.t developed hungry bone syndrome.