Multiple brown tumors—Forgotten pathology in times of calcimimetics: A case report and literature review

Merino, José Carlos de la Flor; Justo, Pablo; Domínguez, Juan José; Gómez-Berrocal, Ana; Seva, Antonio E.; Marschall, Alexander; Rodeles, Miguel

doi:10.1177/2050313x211039383

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…Surgical removal of brown tumor may be necessary in cases where the tumor induces compressive neurological syndromes, poses a high risk of fracture, results in significant deformity affecting normal functions like mastication or breathing, or persists with pain or other symptoms despite effective control of hyperparathyroidism. Bone scintigraphy can be done in order to characterize the lesions [19].…”

Section: Discussionmentioning

confidence: 99%

Case Report on Brown Tumor: An Unusual Expression of Renal Osteodystrophy and Secondary Hyperparathyroidism

Krishna,

Nair,

K F

et al. 2024

IJMPCR

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The new term of ‘Chronic Kidney Disease- Mineral and Bone Disorders’ has been introduced to encompass a wide-ranging syndrome, capturing various abnormalities in bone and mineral metabolism seen in patients with chronic kidney disease. Multifactorial disorders affecting mineral metabolism and bone structure emerge early in the progression of Chronic Kidney Disease. Brown tumors, an uncommon type of bone lesion are distinctive manifestations of high-turnover bone disease. In this case, a patient with chronic kidney disease (dialysis dependent) with IgA nephropathy that presented with multiple osseous lesions of bilateral ribs, sternum, scapula, clavicle, mandible and vertebral bodies. The case highlights the significance of considering brown tumors in the differential diagnosis and management of patients with both an osseous mass and chronic kidney disease. Failing to establish an accurate diagnosis may result in unnecessary additional diagnostic procedures and extensive surgery, ultimately increasing patient morbidity. Through this case report, the importance of preventing, early diagnosing, and treating secondary hyperparathyroidism to reduce the prevalence of high-turnover bone disease and associated complications such as brown tumors is emphasized.

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Section: Discussionmentioning

confidence: 99%

Case Report on Brown Tumor: An Unusual Expression of Renal Osteodystrophy and Secondary Hyperparathyroidism

Krishna,

Nair,

K F

et al. 2024

IJMPCR

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“…In contrast, MR images are useful to differentiate between solid and cystic lesions of brown tumors. In Table I, we summarized the MRI findings from previous reports (Table I) (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). In MR images, solid components have heterogenous signal intensity on T2-weighted images, whereas cystic components have hyperintensity on T2-weighted images (35).…”

Section: Discussionmentioning

confidence: 99%

Multiple Bone Cysts Caused by Hyperparathyroidism: A Case Report and Review of the Literature

MIWA,

TANAKA,

AIBA

et al. 2023

CDP

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Background: Brown tumor, a skeletal complication of severe hyperparathyroidism, comprises reparative granulation tissue and proliferating fibrous tissue with hemosiderin deposition. Multiple brown tumors are extremely rare complications of primary hyperparathyroidism. Case Report: A 41-year-old woman presented with pain in the left knee. Radiography showed multiple cystic lesions in both femurs and the left proximal tibia, and additional radiography showed multiple cystic lesions in the left humerus and ulna. Magnetic resonance imaging (MRI) revealed multiple cystic lesions in the bilateral femurs, left proximal tibia, and ilium. Laboratory tests revealed hypercalcemia (albumin-corrected calcium level, 13.9 mg/dl), hypophosphatemia (phosphate level, 1.6 mg/dl), elevated level of alkaline phosphatase level (614 U/l), and markedly elevated parathyroid hormone (PTH) level (1,070 pg/ml; normal range=10-65 ng/l). 99mTc-hexakis-2-methoxyisobutyl-isonitrile scintigraphy revealed tracer accumulation in the left upper parathyroid gland, which was consistent with parathyroid tumor. Although resection of the parathyroid tumor was planned, the patient developed parathyroid apoplexy before tumor excision. After the parathyroid apoplexy, serum calcium and PTH levels temporarily normalized. Resurgence of the PTH level was observed 2 years after the diagnosis, and the patient underwent left upper parathyroidectomy. One year after the tumor excision, the patient had no symptoms, and MRI showed shrinkage of the cystic bone lesions. Conclusion: This report emphasizes the importance of considering hyperparathy-roidism as a differential diagnosis for patients with multiple bone lesions.

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“… 13 Brown tumours often overlooked in patient with underlying end-stage renal failure disease as calcimemtic and vitamin D analogues were used as treatment for secondary hyperparathyroidism. 14 …”

Section: Discussionmentioning

confidence: 99%

Primary hyperparathyroidism presenting with sudden onset paraplegia

Zainordin

Azraai

Shah

et al. 2022

SAGE Open Medical Case Reports

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A 48-year-old female with long-standing type 2 diabetes mellitus presented with acute onset of bilateral lower limb weakness. She had been previously well and denied any constitutional symptoms. Physical examinations revealed generalized lower limb weakness with bilateral lower limb hypotonia, power of 0 over 5, reduced deep tendon reflexes, and loss of peripheral sensations up to the level of T10. Upper limb functions were normal. Rectal examination showed a lax anal tone and reduced anal grip. Blood investigations showed elevated serum alkaline phosphatase, corrected serum calcium, and parathyroid hormone. Magnetic resonance imaging of the spine revealed an expansile mass at the posterior element of the ninth thoracic vertebrae, causing spinal compression with possible impingement of the right T9 exiting spinal nerve. An urgent surgical decompression and tissue biopsy were performed for stabilization of the spine. Intraoperative findings included spinal cord compression secondary to an epidural tumour mass extending from T9 to T10 disc levels. Histopathological analysis showed a giant cell tumour of the spine. A 99mTc Sestamibi-SPECT parathyroid scintigraphy showed an ectopic parathyroid adenoma at the left suprasternal region. A diagnosis of Brown tumour secondary to ectopic parathyroid adenoma was made. She underwent an exploratory parathyroidectomy procedure with removal of the ectopic parathyroid gland, which resulted in a normalization of the serum calcium and parathyroid hormone. Unfortunately, her lower limb functions did not return to normal, and she remained paraplegic at 6 months postoperatively.

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Multiple brown tumors—Forgotten pathology in times of calcimimetics: A case report and literature review

Cited by 7 publications

References 15 publications

Case Report on Brown Tumor: An Unusual Expression of Renal Osteodystrophy and Secondary Hyperparathyroidism

Case Report on Brown Tumor: An Unusual Expression of Renal Osteodystrophy and Secondary Hyperparathyroidism

Multiple Bone Cysts Caused by Hyperparathyroidism: A Case Report and Review of the Literature

Primary hyperparathyroidism presenting with sudden onset paraplegia

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