Brown tumor of the cervical spine: a case report and review of the literature

Abstract

Brown tumors (BT) are benign focal bone lesions that may appear in the context of primary and secondary hyperparathyroidism (HPT). Involvement of the spine is exceedingly rare. We present a case of brown tumor involving the cervical spine, the third reported in the literature. In the literature review (until August 2010), we found nine cases of spinal BT in primary HPT and 14 cases in secondary HPT. Fifteen patients (65%) had evidence of spinal cord compression. A 34-year-old woman on long-term hemodialysis, with secondary HPT, presented with a 9-month history of persistent neck pain. Radiographs of the cervical spine revealed an expansive osteolytic lesion in the posterior arch of the second cervical vertebra. MR imaging revealed an expansive mass on C2 affecting the vertebral body, odontoid process, right pedicle, laminas, and spinous process; there were no signs of spinal edema. A CT-guided needle biopsy of the lesion showed destruction of trabecular bone, infiltration of the fibroblastic cells, and abundant osteoclast-like multinucleated giant cells with hemorrhage and hemosiderin pigment, and the diagnosis of brown tumor was made. Cervical pain disappeared within a few days of parathyroidectomy, and rapid remineralization of C2 was evident within a few months. BT must always be considered in the context of hyperparathyroidism and osteolytic lesions. Vertebral BT can be particularly devastating due to medullar compression symptoms. Regression or complete disappearance of these lesions after parathyroidectomy is common, but prompt surgical decompression is necessary in case of medullar compression symptoms.

Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature

“…[3233] Total or subtotal parathyroidectomy is valuable for treatment of BT; it usually provides complete clearance of the lesions with remineralization of the vertebra. [11223] It eliminates excessive activation of the PTH and usually leads to significant regression of BT. [18] Fargen et al .…”

Two rare manifestations of primary hyperparathyroidism: paralysis and peptic ulcer bleeding

“…If brown tumor has pressure effect on the spinal column, it can cause either slowly progressive symptom or acute spinal cord compression, producing paraplegia or paresthesia. In evaluation of 23 cases with spinal brown tumor (between 1977 and 2011), 15 had evidence of spinal cord compression with paraplegia or paresthesia (8). In X-ray, brown tumor is seen as expansile lytic lesion that is mostly well defined.…”

A case report of brown tumor in a patient with chronic renal failure and renal cell carcinoma

“…Brown tumor may occur as an isolated focus or as multifocal lesions mimicking bone metastases . The non‐specific radiographic characteristics of this disease make it difficult to distinguish brown tumors from bone metastases, primary bone tumors, multiple myeloma, and non‐neoplastic bone lesions (Table ).…”

“…On radiological examination, the lesions may present as expansile, multilocular and/or cystic . Brown tumors share some common clinical, radiographic, cytologic, and histologic features with more aggressive lesions such as metastases, multiple myeloma, and giant cell tumor of bone . Particularly, in the case of a pre‐existing malignancy, metastasis should be considered first in the differential diagnosis.…”