Right Tibia Brown Tumor Revealing Primary Hiper Parathyroidism : A Case Report (original) (raw)
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Brown Tumor of Lower Right Limb in Patients With Primary Hyperparathyroidism: A Case Report
Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI)
Background.Brown tumor of Hyperparathyroidism is a metabolic disorder that can affect the entire skeleton and reactive process due to bone resorption caused by primary or secondary hyperparathyroidism (HPT). Brown tumors can occur as solitary or multiple lesions in any bone, most often in the pelvis, ribs, clavicle, mandibula, and extremities. Here, we report the Brown tumor in the lower right limb in patients with primary HPT, and the literature is reviewed. Case presentation. Patients was women 30 years old had married and come with main complains of difficulty walking. This condition has been experienced by patients since diagnosis with lunb of tibia last 8 months and caused pain from hip to lower leg. On laboratory results, it showed elevated PTH 1.249 (normal 15-65) pg/dL, elevated phosphatase alkali 1156 (normal 40-150) u/dL, elevated Ca 10,8 (n:8,6 -10,3) mg/dL, phosphor 2,1 (3–4,5) mg/dL. Histology examination of tibia lump was a benign lesion of bone (Brown Tumor). Ultraso...
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 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.
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.
Brown tumor of the femur associated with double parathyroid adenomas
Saudi medical journal, 2004
Severe parathyroid bone disease is a rare clinical presentation of primary hyperparathyroidism. Double parathyroid adenomas are even more rare cause of primary hyperparathyroidism. The authors present a case of double parathyroid adenomas in a 48-year-old man, who presented with painful left lower limb swelling, which was slowly growing in size in the last 20 years. Magnetic resonance imaging revealed a cystic bony lesion and coincidentally, a urinary bladder calculus. Biopsy of the mass revealed giant cell lesion. Laboratory investigations showed hypercalcemia and hypophosphatemia with elevated parathyroid hormone level. A computerized tomography scan of the neck delineated an adenoma of the left superior parathyroid gland, which was surgically removed. The left inferior parathyroid was also enlarged and was removed. Histological diagnosis confirmed double parathyroid adenomas. The rarity and the interesting clinical presentation of such association are discussed.
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.
Brown Tumor and Hyperparathyroidism in Orthopaedic Surgery
2021
Amaç: Primer hiperparatiroidizmi (PHPT) olup yanlış tanı ve tedaviye yönlendirilebilecek hastalar için, ortopedik cerrahi öncesinde daha iyi analiz edilmesine yol gösterecek bir çalışma planladık. Gereç ve Yöntem: 2003-2017 yılları arasında ortopedi polikliniğimize başvuran, kemik lezyonu veya kırığı nedeniyle muayene edilip tedavi edilen ve PHPT tanısı alan 12 hasta çalışmaya alındı. Hastalar adenektomi için genel cerrahi kliniğine sevk edildi. Adenektomi sonrası kistlerin durgunluğunu takip etmek için direkt radyografi kullanıldı. Bulgular: Hastaların ortalama yaşı 36,6±13,4 yıl idi. Çalışmaya dahil edilen hastaların 7'si kadın, 5'i erkekti. Üç hastada bireysel kemik tutulumu gözlenirken, 9 hastada çoklu kemik tutulumu gözlendi. Sekiz hastada patolojik kırık vardı. Artmış osteoklastik aktivite ve çok çekirdekli dev hücreler gösteren tüm hastalara biyopsi yapıldı ve bu bulgular için bir rapor yayınlandı. Sonuç: Brown tümör, hiperparatiroidizm sırasında kemik dokularında gelişen çok nadir reaktif lezyonlardır. Kistik ve litik lezyonlar için kesin bir tanı koymak için, hastanın klinik durumundan şüphelenmek ve olası herhangi bir tanıyı akılda tutmak gerekir. Anahtar kelimeler: Brown tümör, dev hücreli tümör, primer hiperparatiroidizm, metastatik kemik lezyonu
Journal of Clinical and Translational Endocrinology: Case Reports, 2019
Brown tumors of bone are highly vascular, lytic bone lesions representing a reparative cellular process rather than a neoplastic process seen in patients with hyperparathyroidism. These tumors may behave aggressively and can be destructive. We present a case of 33 year old male who presented with progressively increasing swelling in right leg region. A lytic lesion involving right tibia was seen in regional CT which was suspicious for malignancy. Whole body F18-FDG PET-CT was done for further evaluation. PET-CT showed multiple sites of skeletal lesions with a large mass in right lobe of thyroid gland. Biopsy from tibial lesion revealed it to be osteoclast rich tumor raising a possibility of parathyroid mass with multiple brown tumors. Biochemical parameters revealed high Serum Calcium, Serum Total Alkaline Phosphatase and Serum parathyroid hormone (S. PTH). 99mTehnitium Sestamibi (99 m Tc MIBI) imaging was done which localized a right superior parathyroid adenoma with a suspicious right inferior parathyroid adenoma. The patient underwent right superior and inferior parathyroidectomy along with right hemithyroidectomy. Intra-operative fresh S.PTH sample was sent which dropped down to 73.4 ng/ml from 1500 ng/ml. Brown tumor is a potential cause of false-positive result in evaluation of a patient for unknown primary tumor or skeletal metastases with F18-FDG PET-CT imaging.
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].
International Journal of Innovative Research in Medical Science
Background: Brown tumors, also known as osteitis fibrosa cystica, are focal benign bone lesions caused by an increased osteoclastic activity because of high levels of parathyroid hormones. The increase of parathyroid hormones can be primary hyperparathyroidism (HPT) and secondary HPT resulting from renal failure and vitamin D deficiency. Case presentation: A 26-year-old Thai female visited the clinic because of right leg pain and swelling for three weeks. Plain radiography revealed a solitary osteolytic lesion with an impending fracture at the anterior cortex of the right proximal tibia. The patient underwent a core needle biopsy. The initial histopathology report depicted a giant cell lesion. In addition, the patient had elevated serum parathyroid hormones. A parathyroid adenoma was discovered on a further investigation with contrast-enhanced computed tomography of the neck. The immunochemistry and molecular study report were consistent with a brown tumor. The patient underwent par...