Brown tumor due to primary hyperparathyroidism resulting in acute paraparesis: Case report and literature review

Abstract

Background: Brown tumor (Osteoclastoma) is a rare benign, focal, lytic bone lesion most commonly attributed to a parathyroid adenoma; it occurs in approximately 5% of patients with primary hyperparathyroidism, and 13% of patients with secondary hyperparathyroidism. Most tumors are located in the mandible, pelvis, ribs, and large bones; only rarely is it found in the axial spine. Case Description: A 37-year-old male with primary hyperparathyroidism presented with an MR-documented T4 and T5 brown tumor (Osteitis Fibrosa Cystica) resulting in an acute paraparesis. The patient successfully underwent excisional biopsy of an expansile, enhancing, bony destructive lesion at the T4-5 level. Subsequently, he required subtotal excision of a left upper parathyroid tumor. Conclusion: Patient with primary hyperparathyroidism may acutely present with paraparesis attributed to brown tumors of the spine warranting emergent operative decompression.

Spinal cord compression caused by a brown tumor secondary to primary hyperparathyroidism

“…[ 7 - 22 ] The differential diagnoses these spinal lesions included; metastatic tumors, multiple myeloma, plasmacytoma, giant cell tumors, lymphoma, and aneurysmal bone cysts. [ 12 - 18 ]…”

“…Most patients were female (62.9 %) averaging 46.5 years of age who presented with predominant thoracic lesions (59%) contributing to varying degrees of myelopathy [Table 1]. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Surgical options included; biopsy, decompression/resection, or decompression/ instrumentation with fusion. Of the 25, 23 benefitted from parathyroidectomy.…”

“…Typically, CT imaging documented BTs as well-defined soft-tissue masses with local bony erosion, expansion, while on magnetic resonance imaging studies, these lesions appear hypointense on T1, hypo-or hyperintense on T2-weighted images, with homogenous contrast enhancement. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] e differential diagnoses these spinal lesions included; metastatic tumors, multiple myeloma, plasmacytoma, giant cell tumors, lymphoma, and aneurysmal bone cysts. [12][13][14][15][16][17][18] e gold standard for the treatment for BTs due to primary hyperparathyroidism remains gross total removal of the spine lesion (i.e., biopsy, decompression with/without fusion for those with neurological deficits) followed by parathyroidectomy.…”

“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] e differential diagnoses these spinal lesions included; metastatic tumors, multiple myeloma, plasmacytoma, giant cell tumors, lymphoma, and aneurysmal bone cysts. [12][13][14][15][16][17][18] e gold standard for the treatment for BTs due to primary hyperparathyroidism remains gross total removal of the spine lesion (i.e., biopsy, decompression with/without fusion for those with neurological deficits) followed by parathyroidectomy. [7][8][9][10][11][12][13][14][15][16][17][18]…”

A patient with femoral osteitis fibrosa cystica mimicking bone neoplasm: a case report

“…Osteitis fibrosa cystica (OFC) is a a rare, osteolytic and nonneoplastic metabolic bone disease [ 1 ]. The activation of osteoclast in OFC is due to increased endogenous parathyroid hormone (PTH) [ 2 ].…”