Giant cell tumor of bone in a patient with diagnosis of primary hyperparathyroidism: a challenge in differential diagnosis with brown tumor

Rossi, Barbara; Ferraresi, Virginia; Appetecchia, Marialuisa; Novello, Mariangela; Zoccali, Carmine

doi:10.1007/s00256-013-1770-9

Cited by 26 publications

(43 citation statements)

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“…Clinically, they cause swelling, bone pain and pathological fractures. On imaging, they appear as lytic lesions with welldefined margins and sometimes a sclerotic rim (2,3,4). Biopsy is the gold standard for definitive diagnosis of BTs, showing lobules separated by fibrous septa and composed of fibroblasts, extravasated red blood cells, hemosiderinladen macrophages and scattered multinucleated giant cells that cluster around areas of hemorrhage (4).…”

Section: Discussionmentioning

confidence: 99%

“…Among giant cell-containing lesions of the bone, one of the main differential diagnoses of BTs is GCTs (3,4). These are mainly benign bone tumors that also manifest with bone pain and swelling.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, although they cause the same symptoms, they affect different parts of the skeleton. BTs can develop in various bones, while GCTs mostly arise in the epiphysis and metaphysis of long bones in patients with closed growth plates (2,3,4), making the iliac crest a very unusual site for a GCT. Moreover, GCTs present generally as solitary bone lesions, whereas BTs are frequently multiple.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, GCTs present generally as solitary bone lesions, whereas BTs are frequently multiple. On histological evaluation, they are both composed of a fibrotic stroma with multinucleated giant cells (3,4). However, the mononuclear cells are round in GCTs but spindled in BTs, and giant cells tend to be distributed uniformly in GCTs, while, in BTs, they are arranged in clusters around areas of hemorrhage (3,4).…”

Section: Discussionmentioning

confidence: 99%

“…The differential diagnosis of BTs includes various giant cell-containing bone lesions (Table 1), among which are giant cell tumors (GCTs) (3,4). The distinction between these two conditions can be challenging, sometimes leading to diagnostic errors and unnecessary surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

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Brown tumor of the iliac crest initially misdiagnosed as a giant cell tumor of the bone

Hamidi

Mottard

Berthiaume

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Brown tumors (BTs) are expansile osteolytic lesions complicating severe primary hyperparathyroidism (PHPT). Clinical, radiological and histological features of BTs share many similarities with other giant cell-containing lesions of the bone, which can make their diagnosis challenging. We report the case of a 32-year-old man in whom an aggressive osteolytic lesion of the iliac crest was initially diagnosed as a giant cell tumor by biopsy. The patient was scheduled for surgical curettage, with a course of neoadjuvant denosumab. Routine biochemical workup prior to denosumab administration incidentally revealed high serum calcium levels. The patient was diagnosed with PHPT and a parathyroid adenoma was identified. In light of these findings, histological slices of the iliac lesion were reviewed and diagnosis of a BT was confirmed. Follow-up CT-scans performed 2 and 7 months after parathyroidectomy showed regression and re-ossification of the bone lesion. The aim of this case report is to underline the importance of distinguishing BTs from other giant cell-containing lesions of the bone and to highlight the relevance of measuring serum calcium as part of the initial evaluation of osteolytic bone lesions. This can have a major impact on patients’ management and can prevent unnecessary invasive surgical interventions. Learning points: Although rare, brown tumors should always be considered in the differential diagnosis of osteolytic giant cell-containing bone lesions. Among giant cell-containing lesions of the bone, the main differential diagnoses of brown tumors are giant cell tumors and aneurysmal bone cysts. Clinical, radiological and histological characteristics can be non-discriminating between brown tumors and giant cell tumors. One of the best ways to distinguish these two diagnoses appears to be through biochemical workup. Differentiating brown tumors from giant cell tumors and aneurysmal bone cysts is crucial in order to ensure better patient care and prevent unnecessary morbid surgical interventions.

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