A case of brown tumor mimicking fibrous dysplasia in a patient with chronic renal failure

Abstract

Renal osteodystrophy is one of the major causes of morbidity in patients receiving long-term dialysis treatment for renal failure and after transplantation. Its clinical implications include high-turnover bone disease, low-turnover bone disease, osteomalacia, osteosclerosis, and osteoporosis. A 13-year-old boy who had been on dialysis treatment for renal failure was admitted with a pathologic supracondylar femur fracture after a minor trauma. Radiological studies showed cystic lesions in the femoral supracondyle, left acetabular roof, and right proximal and distal tibia. Based on radiologic appearances of the lesions and on histopathologic findings of the lesion excised from the right distal tibia, brown tumor and fibrous dysplasia were considered in the differential diagnosis. Initially, serum parathyroid hormone level was slightly increased and calcium level was normal, but during follow-up, serum parathyroid hormone level increased significantly, enabling the diagnosis of brown tumor.

An Unusual Presentation of Primary Hyperparathyroidism: Pathological Fracture

“…These tumors may appear in any bone but are frequently found in the facial bones and jaws, sternum, pelvis, ribs, femur, and rarely the vertebrae [6]. The histological findings of the tumor are similar to those of giant cell tumors and aneurismal bone cyst and may cause confusion in diagnosis [7]. Nevertheless, because of the difficulty of microscopic differential diagnosis, the clinical presentation and the biochemical findings should be considered carefully for making the correct diagnosis.…”

“…In addition to the surgical stabilization of the femur, aggressive treatment of hyperparathyroidism is also necessary to achieve successful outcomes. Thus, the increased risk of fracture disappears within a year following surgery suggesting a quick restoration of bone biomechanical competence [7]. …”

Four Extremity Fractures in a Patient With Renal Osteodystrophy

“…Any bone may be affected, but most frequently pelvis, ribs, femora and facial bones. Through x‐rays, Brown tumours appear lytic sharply demarcated central or eccentric expansile lesions (Jevtic et al 2003; Yalcin et al 2008).…”

Epistaxis as an initial symptom of brown tumor in hard palate: a rare case report and review

“…Laboratory tests of serum phosphate and calcium levels, and parathyroid hormone levels should always be included in the routine examination of patients with multifocal osteolytic lesions [24]. However, for patients with only a slightly elevated serum parathyroid hormone level and normal blood calcium levels, particularly among those with vitamin D deficiency, follow-up tracking is vital for an accurate diagnosis at the early stage [14,22,25,26].…”