Brown Tumors or Bone Metastases in Context of Parathyroid Carcinoma: A Diagnostic Challenge (original) (raw)
Related papers
Diagnostics, 2015
Parathyroid carcinoma only represents <1% of all cases of primary hyperparathyroidism (PHPT). Even rare, chronic PHPT may lead to excessive osteoclast activity, and the increased resorption leads to destruction of cortical bone and formation of fibrous cysts with deposits of hemosiderin-so-called brown tumors. These benign, osteolytic lesions may demonstrate FDG-avidity on 18 F-FDG PET/CT, and as such are misinterpreted as skeletal metastases. Regression of the lesions may occur following successful treatment. We present a case demonstrating the diagnostic work-up and follow-up of a patient with PHPT due to parathyroid carcinoma and with presence of brown tumors on 18 F-FDG PET/CT, visualizing the possible role of this imaging modality in the evaluation of treatment response in these patients.
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.
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.
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.
Mediastinal Parathyroid Adenoma Mimicking Cancer Metastatic to Bone
AACE clinical case reports, 2017
Objective: Mediastinal parathyroid adenomas are rare in clinical practice. We report a case that mimicked cancer metastatic to bone on initial workup to increase awareness of this differential diagnosis in the evaluation of patients presenting with multiple foci of uptake on technetium bone scanning without an established primary neoplasm. We also outline other diagnostic pitfalls that may be encountered in the workup and management of this uncommon condition. Methods: A 26-year-old man presented with a several-month history of back and pelvic pain. Initial plain radiography showed multiple lytic lesions in the pelvis. Technetium bone scanning revealed multiple foci of increased uptake in the thoracic vertebrae, ribs, clavicles, pelvis, and extremities. Results: A computed tomography (CT) scan demonstrated a mediastinal mass and an initial diagnosis of metastatic disease from a mediastinal primary malignancy was entertained. Further workup revealed markedly elevated serum ionized calcium of 1.97 mmol/L (normal, 1.19 to 1.31 mmol/L) and parathyroid hormone (PTH) of 154.8 pmol/L (normal, 2.0 to 9.4 pmol/L). Parathyroid scintigraphy showed intense tracer accumulation in the anterior mediastinal mass. A median sternotomy was performed and histopathology was consistent with a parathyroid adenoma. Postoperatively, the patient's ionized calcium and PTH levels normalized and pain resolved. Conclusion: This case illustrates two clinical pearls: (1) brown tumor secondary to hyperparathyroidism is an important differential in the evaluation of patients presenting with widespread lytic bone lesions on CT or multiple foci of uptake on bone scan; and (2) the mediastinum is a rare location but should be considered in the workup of primary hyperparathyroidism.
A Brown Tumor Simulating Bone Metastases
2016
Primary hyperparathyroidism usually presents with renal, gastrointestinal, mental and skeletal signs and symptoms. Brown tumor is a benign lesion that arises as a direct result of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. Multiple brown tumors may simulate a malignant neoplasm and it is a real challenge for the clinicians in the differential diagnoses. Here, we present a 68-year-old man with multiple lytic lesions in pelvis bones, highly suspicious for metastatic malignancy that finally we found that the patient had primary hyperparathyroidism.
Primary hyperparathyroidism having multiple Brown tumors mimicking malignancy
Indian Journal of Endocrinology and Metabolism, 2012
Primary hyperparathyroidism is a disease characterized by excessive secretion of parathormone. During the course of this disease, bone loss occurs, particularly depending on resorption of the skeletal system. One of the complications of primary hyperparathyroidism is fi brotic, cystic bony changes which is called Brown tumor. Skeletal manifestations in the form of Brown tumors are rare and according to literature occur in less than 2% of patients suffering from any form of hyperparathyroidism. Such rare and multiple benign lesions may simulate a malignant neoplasm and pose a real challenge for the clinician in its differential diagnosis. We present a case of a 23-year-old Indian woman who was evaluated for multiple lytic expansile lesions with a strong suspicion of malignancy and fi brous dysplasia but turned out to be a case of primary hyperparathyroidism.
Journal of the Egyptian National Cancer Institute, 2021
Background: Brown tumors are benign osteoclastic bone lesions encountered in patients with hyperparathyroidism. These tumors may demonstrate aggressive, destructive features in the skeleton and imitate metastatic bone lesions, particularly in patients with known primary neoplasm. In this case report of recurrent papillary thyroid cancer and ectopic parathyroid adenoma, we shed light on the importance of combining different nuclear medicine imaging modalities to differentiate brown tumors from metastatic bone lesions. Case presentation: We present a 39-year-old woman with a known history of papillary thyroid carcinoma classic type stage pT1N1b post-total thyroidectomy and radioactive iodine (I-131) therapy (RAI) presented with upper limb weakness and pain. An expansile lytic lesion involving the 6th cervical vertebra was seen in cervical spine MRI, which was suspicious for metastatic deposit. Therapeutic and diagnostic I-131 whole-body scans were negative for any I-13-avid lesions. Laboratory results revealed high calcium, parathyroid hormone, and alkaline phosphatase. A Technetium-99m-sestamibi (Tc-99m MIBI) scan was done with the standard protocol of spot views to the neck and upper chest area to localize any suspicious parathyroid adenoma. The scan demonstrated right supraclavicular and mediastinal Tc-99m MIBI-avid lesions suspicious for being ectopic parathyroid adenomas. Whole-body fluorine-18-2fluoro-2-deoxy-D-glucose (18 F-FDG), positron emission tomography/computed tomography (PET/CT) (18 F-FDG PET/ CT) was performed for further evaluation. It demonstrated multiple focal lytic skeletal lesions of abnormal increased FDG uptake as well as right supraclavicular FDG-avid lymph nodes. However, the superior mediastinal lesion was non-FDG-avid, suggesting the existence of two different entities: ectopic parathyroid adenoma with multiple brown tumors and metastatic right supraclavicular lymph nodes. The patient underwent right neck dissection and superior mediastinal mass excision. An intra-operative fresh serum parathyroid sample was sent, which dropped down to 100ng/ml from 863.7ng/ml. Later, histopathological results revealed that the right supraclavicular lymph nodes were metastatic papillary thyroid carcinoma. At the same time, the superior mediastinal mass proved to be parathyroid adenoma by histopathology, confirming the 18 F-FDG PET/CT findings.
Human Pathology: Case Reports, 2020
Introduction: Hyperparathyroidism is a condition caused by hyperactivity of parathyroid glands. It can cause a lytic bone lesion which similar to a Giant Cell Tumor (GCT) and is hard to differ from it. The common terms for these tumor-like bone lesions are osteitis fibrosa cystica or brown tumor and they represent the end stage of bone remodeling process in prolonged hyperparathyroidism. Case presentation: A 53-year-old female complained about pain around her right shoulder. Radiographic appearance showed that there are multiple lytic lesions on right proximal humerus and some other bones. Histopathology revealed that it was most consistent to GCT of the bone. Patient underwent tumor resection surgery and shoulder hemiarthroplasty. Post-operative evaluation showed that there was an increased level of serum calcium and ionized calcium, but decreased level of phosphate. Parathyroid hormone level was high. Patient was suggested to undergo further thorough examination for the underlying cause of hyperparathyroidism. But unfortunately, a couple months after surgery, patient passed away. Discussion: Based on the history, clinical, laboratory, and radiograph findings, we thought about multiple myeloma or metastatic bone disease at first. After histopathology report said that it was most consistent to GCT of the bone. We thought about multifocal GCT of the bone then. Since the incidence of multifocal GCT was considered very rare, the lesions were multiple, and the clinical condition was not suitable for GCT, we thought about possibility of metabolic condition. Further laboratory examination of serum calcium and phosphate turned out to be hypercalcemia and hypophosphatemia. Thus we thought about brown tumor of hyperparathyroidism. Parathyroid hormone level was checked later and turned out to be high. Conclusion: Brown tumor of hyperparathyroidism should be considered when we found a case of multifocal osteolytic bone lesions. Normally, we would thought about multiple myeloma or metastatic bone disease at first. But when the laboratory, radiographic and histopathological examination results did not correlate to those diagnosis, we should order serum calcium, phosphate and parathyroid hormone level evaluation for patients with multiple osteolytic lesions. Any misdiagnosis and further harmful mistreatment for patients should be avoided.