Brown Tumor With Spine Involvement at Multiple Levels in a Hemodialysis Patient

Abstract

Brown tumor of the bone or osteitis fibrosa cystica is a rare manifestation of hyperparathyroidism, most seen nowadays in association with secondary and tertiary hyperparathyroidism. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are the major culprits of secondary hyperparathyroidism (sHPTH). CKD is known to cause phosphate retention and a decrease in 1,25-dihydroxyvitamin D and ionized calcium levels, which in turn trigger the PTH secretion. Brown tumor can affect the jawbones, femur, sternum, ribs, and rarely the spine. We present the case of a 60-year-old male with ESRD on hemodialysis who was found to have lytic bone lesions in the thoracic and lumbar spine. Initially, malignancy was suspected. Blood work revealed markedly elevated PTH at 3,563 pg/mL, hypocalcemia, and hyperphosphatemia. Biopsy of the L5-S1 lesion was consistent with reactive changes due to sHPTH. Once a diagnosis of the brown tumor was confirmed, the patient was started on cinacalcet and was referred for parathyroidectomy.

Massive brown tumors of the jaw: A case report

“…It can affect all bones such as the femur, sternum, ribs, and rarely facial regions (jawbone such as our case, palatinal bone, nasal, and orbital sinuses), and may be monostotic or polyostotic. 2,3…”

“…The main mimickers are fibrous dysplasia, metastatic carcinoma or aneurysmal bone cyst, 3 giant cell tumor, granuloma, ossifying fibroma, lytic metastasis from cancer and multiple myeloma when the clinical context is concordant and lesions are multiple. 2…”

“…It can affect all bones such as the femur, sternum, ribs, and rarely facial regions (jawbone such as our case, palatinal bone, nasal, and orbital sinuses), and may be monostotic or polyostotic. 2,3 Clinical symptoms depend on the topography of the lesions: Pain is usually caused by pathological microfractures caused by the lesion. 1 Patients with primary HPTH may also have gastrointestinal and neurological complaints, as well as kidney stones.…”

“…It may be associated with bone destruction and pathological features. 2,3 Despite the fairly obvious features, imaging can be variable and some tumors may be ill defined, mixed with both a lytic and sclerotic component, associated with adjacent soft tissue involvement, which makes it hard to differentiate with a malignant lesion. 4 The main mimickers are fibrous dysplasia, metastatic carcinoma or aneurysmal bone cyst, 3 giant cell tumor, granuloma, ossifying fibroma, lytic metastasis from cancer and multiple myeloma when the clinical context is concordant and lesions are multiple.…”

“…If medical treatment fails, a parathyroidectomy is preferred, 3 and leads to regression of the tumor in most cases. For masses causing esthetic and functional problems in patients not responding to conservative therapy and parathyroidectomy, complete surgical removal of the tumoral masses may be necessary.…”