RESUMO
RATIONALE: Brown tumor (BT), an uncommon focal lytic bone tumor, is a non-neoplastic and reactive process caused by increased osteoclastic activity and fibroblastic proliferation in primary or secondary hyperparathyroidism. Vertebral tumor causing neural compression is relatively rare, especially in the cervical spine. PATIENT CONCERNS: A 29-year-old man developed neck pain and arm radicular pain 4 months ago, with the level of serum calcium significantly higher than normal. Computed tomography scan of the cervical spine revealed an expansile lytic lesion occupying the C6 body, left pedicle, and left lamina of C5-6. DIAGNOSES: Osteoclastoma according to imaging and histopathological results. INTERVENTIONS: A laminectomy of C5-6 was performed. OUTCOMES: One month later, he was re-hospitalized due to nausea and vomiting and the serum calcium, was still, kept at a high level. Additionally, the parathormone (PTH) was greatly higher than normal. BT with primary hyperparathyroidism due to the parathyroid tumor was considered. After the surgery of the right parathyroid gland was performed, serum calcium and PTH both decreased, and computed tomography showed good recovery. LESSONS: BTs might be misdiagnosed as other giant cell tumors, thus when giant cell tumors are considered, serum calcium and PTH examination may be needed to exclude BTs.
Assuntos
Neoplasias Ósseas , Tumor de Células Gigantes do Osso , Hiperparatireoidismo Primário , Osteíte Fibrosa Cística , Adulto , Humanos , Masculino , Neoplasias Ósseas/complicações , Cálcio/sangue , Vértebras Cervicais/diagnóstico por imagem , Tumor de Células Gigantes do Osso/complicações , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Osteíte Fibrosa Cística/diagnóstico , Osteíte Fibrosa Cística/etiologia , Hormônio Paratireóideo/sangueRESUMO
BACKGROUND: Brown tumour is a rare tumour-like lesion of the bone, which is considered as an end-stage lesion of abnormal bone metabolism caused by persistently high parathyroid hormone (PTH) levels. Brown tumour can be found in any part of the skeleton; in some cases, it can occur in multiple bones and can be easily misdiagnosed as a metastatic tumour. CASE PRESENTATION: We report the case of a 44-year-old man who presented to the Department of Oncology in our hospital with a 2-month history of local pain in his left shoulder joint. The initial diagnosis was an aneurysmal bone cyst by biopsy, for which the patient underwent tumour resection surgery. The diagnosis of a malignant tumour was made again following postoperative pathological examination. The pathological sections and all clinical data were sent to the Department of Pathology of the First Affiliated Hospital of Sun Yat-sen University; the diagnosis made there was brown tumour. His blood PTH level was 577 pg/ml (15-65 pg/ml). Colour Doppler ultrasonography of the parathyroid gland suggested a parathyroid adenoma. For further treatment, the left parathyroid adenoma was removed by axillary endoscopic resection. Postoperatively, a pathologic examination was performed, and the diagnosis of a parathyroid adenoma was confirmed. One year after the surgery, the left humerus was completely healed, and the left shoulder joint had a good range of movement. CONCLUSIONS: In summary, histopathological diagnosis is not sufficient for the diagnosis of brown tumours. A comprehensive analysis combining clinical symptoms with findings of imaging and laboratory tests is also required. Generally, the treatment of brown tumour includes only partial or complete resection of the parathyroid glands. However, when the tumour is large, especially when it involves the joint, surgery is indispensable.
Assuntos
Hiperparatireoidismo Primário/diagnóstico , Osteíte Fibrosa Cística/diagnóstico , Adulto , Erros de Diagnóstico , Humanos , Hiperparatireoidismo Primário/complicações , Masculino , Osteíte Fibrosa Cística/etiologiaRESUMO
Hyperparathyroidism is one of the most common endocrine disorders worldwide. In countries where routine biochemical screening is not common, symptomatic hyperparathyroidism predominates. Its manifestations include skeletal alterations, calcification of soft tissues, kidney stones, and functional alterations in other systems. Notably, jaw alterations can be the first clinical sign of hyperparathyroidism, including brown tumor, renal osteodystrophy, osteitis fibrosa, and leontiasis ossea, and knowing such conditions is of core importance for the multidisciplinary diagnosis and management of hyperparathyroidism. We aimed to perform a concise review, systematizing the concepts and mechanisms underlying hyperparathyroidism and associated gnathic alterations. In addition, a detailed description of the clinical aspects of the jaw manifestations is presented.
Assuntos
Calcinose , Distúrbio Mineral e Ósseo na Doença Renal Crônica , Hiperostose Frontal Interna , Hiperparatireoidismo , Osteíte Fibrosa Cística , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/terapia , Feminino , Humanos , Hiperostose Frontal Interna/patologia , Hiperparatireoidismo/complicações , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/patologia , Arcada Osseodentária/patologia , Masculino , Osteíte Fibrosa Cística/diagnóstico , Osteíte Fibrosa Cística/etiologia , Osteíte Fibrosa Cística/patologiaRESUMO
Primary hyperparathyroidism is not so uncommon a disease. In high-income countries, with the introduction of routine biochemical testing in 1980s, it is diagnosed early, and the majority are seen as asymptomatic disease. However, in India, a severe symptomatic form is still seen, and many times patients are undiagnosed, thus continuing to suffer debilitating disease. Here, we report such a patient who was being treated as having bony metastases from an unknown primary source, when in fact he had osteitis fibrosa cystica due to primary hyperparathyroidism and was cured after surgery.
Assuntos
Hiperparatireoidismo Primário , Osteíte Fibrosa Cística , Erros de Diagnóstico , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/cirurgia , Índia , Masculino , Osteíte Fibrosa Cística/diagnóstico , Osteíte Fibrosa Cística/cirurgiaAssuntos
Hipercalcemia/etiologia , Hiperparatireoidismo/diagnóstico , Osteíte Fibrosa Cística/diagnóstico , Adolescente , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Hiperparatireoidismo/complicações , Arcada Osseodentária/diagnóstico por imagem , Arcada Osseodentária/patologia , Procedimentos Cirúrgicos Ortognáticos , Osteíte Fibrosa Cística/etiologia , Osteíte Fibrosa Cística/cirurgia , Paratireoidectomia , Tomografia Computadorizada por Raios XRESUMO
In this case report the authors inform about late diagnosis of giant adenoma of the parathyroid gland with primary hyperparathyroidism (PHPT) and the development of fibrocystic osteitis with a «brown¼ tumor of the upper jaw. The patient has been under the care endocrinologist with type 2 diabetes mellitus and multinodular goiter for 8 years.The last 5 years there was a clinical manifestation of PHPT, but the diagnosis was made by an oncologist after the detection of a «brown¼ tumor of the upper jaw. According to multispiral computed tomography and scintigraphy with 99mTc-MIBI, a focal lesion was found in the upper jaw on the right, lytic foci in the bones of the cranial vault, pelvis, lower extremities, ribs on the right, as well as a giant parathyroid adenoma on the right. According to the increased risk of the patient having a malignant neoplasm of the parathyroid gland, an extended surgical treatment of PHPT in the enblock volume was carried out with the achievement of remission of the PHPT. This clinical case illustrates a variant of the severe course of PHPT with the development of such a rare complication as fibrocystic osteitis and demonstrates the importance of timely diagnosis.
Assuntos
Diabetes Mellitus Tipo 2 , Osteíte Fibrosa Cística , Osteíte , Neoplasias das Paratireoides , Diagnóstico Tardio , Diabetes Mellitus Tipo 2/complicações , Humanos , Osteíte Fibrosa Cística/diagnóstico , Neoplasias das Paratireoides/complicaçõesRESUMO
We present the case of a 65-year-old man with brown tumors due to secondary hyperparathyroidism. Magnetic resonance imaging of the pelvis showed multiple lesions with expansive bone appearance. Additionally, prostate cancer was diagnosed during this time. For this reason, differential diagnosis was performed through biopsy of the right iliac bone lesion. Brown tumors are caused by osteoclastic activity and fibroblast proliferation; the differential diagnosis of these bone lesions includes giant tumors, metastases, Paget's disease, and paraneoplastic syndrome with high levels of parathyroid hormone-related peptide (PTHrP). This case report describes the coexistence of two pathologies that could explain these images. In this report, we present a case of a 65-year-old man with brown tumors due to secondary hyperparathyroidism and prostate cancer. In this setting, histologic confirmation is recommended.
Assuntos
Hiperparatireoidismo Secundário , Osteíte Deformante , Osteíte Fibrosa Cística , Neoplasias da Próstata , Idoso , Diagnóstico Diferencial , Humanos , Hiperparatireoidismo Secundário/complicações , Masculino , Osteíte Deformante/complicações , Osteíte Fibrosa Cística/complicações , Osteíte Fibrosa Cística/diagnóstico , Neoplasias da Próstata/complicaçõesRESUMO
BACKGROUND: Primary hyperparathyroidism may present in a myriad of manners, varying from an incidental asymptomatic biochemical finding to gastrointestinal, psychiatric, renal, and bone manifestations. While hyperparathyroidism remains a rare diagnosis in the pediatric population, the initial approach to diagnosis and management of hypercalcemia in children is imperative for the general pediatrician. Herein, we describe an adolescent who presented with a lytic bone lesion and severe, symptomatic hypercalcemia due to primary hyperparathyroidism. CASE PRESENTATION: A 14-year-old male presented with vomiting, constipation, abdominal pain, and lethargy. He had an elevated total corrected calcium of 4.3 mmol/L. He was found to have a large pelvic lytic tumor consistent with a brown tumor due to primary hyperparathyroidism. He received pharmacologic therapy for stabilization of his hypercalcemia, including intravenous saline, intravenous bisphosphonates, and calcitonin. He subsequently received definitive therapy via parathyroidectomy and his post-operative course was complicated by hungry bone syndrome. Long-term follow-up has found full resolution of the lytic lesion and restored calcium homeostasis. CONCLUSIONS: We present this case to highlight the possible presentations of hypercalcemia and hyperparathyroidism that are essential for a general pediatrician to recognize to ensure prompt diagnosis and management. Evaluation for hypercalcemia should be considered in patients with suggestive symptoms and physical exam findings. To our knowledge, this patient represents the first reported pediatric case of a pelvic brown tumor in an adolescent. While the multi-systemic complications of hyperparathyroidism may be quite severe, swift and appropriate management may mitigate these clinical outcomes.
Assuntos
Hipercalcemia , Hiperparatireoidismo Primário , Osteíte Fibrosa Cística , Neoplasias das Paratireoides , Adolescente , Criança , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Masculino , Osteíte Fibrosa Cística/diagnóstico , Osteíte Fibrosa Cística/etiologia , Osteíte Fibrosa Cística/cirurgia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/cirurgia , ParatireoidectomiaRESUMO
BACKGROUND: Primary hyperparathyroidism is characterized by hypercalcemia and elevated or inappropriately normal serum levels of parathyroid hormone. Brown tumor of bone is a rare non-neoplastic lesion resulted from abnormal bone metabolism in hyperparathyroidism. However, nowadays, skeletal disease caused by primary hyperparathyroidism is uncommon. We report a case of brown tumor in the mandible as the initial exhibition of primary hyperparathyroidism associated with an atypical parathyroid adenoma. CASE PRESENTATION: The patient was a 49-year-old female, she had a pain mass on the right mandible a year ago and was treated with root canal therapy and marginal resection. After seven months, the mass recurred and enlarged. Enhanced CT scan, laboratory examination, Ultrasonography, 99mTc-MIBI SPECT-CT scintiscan and pathological examination were used to confirm the diagnosis of brown tumor. The patient's symptom improved after parathyroidectomy. CONCLUSIONS: 99mTc-MIBI SPECT/CT scintigraphy is a highly sensitive examination of the localization diagnosis of hyperparathyroidism. Brown tumors should be considered in the differential diagnosis of osteolytic lesions to avoid unnecessary and harmful interventions.
Assuntos
Hiperparatireoidismo Primário/diagnóstico , Neoplasias Mandibulares/diagnóstico , Osteíte Fibrosa Cística/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Hiperparatireoidismo Primário/cirurgia , Neoplasias Mandibulares/cirurgia , Pessoa de Meia-Idade , Osteíte Fibrosa Cística/cirurgia , Paratireoidectomia , PrognósticoRESUMO
Solid aneurysmal bone cyst (ABC) is a rare subtype of ABC that most commonly involves the small bones of the hands or feet. We present a case of a solid ABC of the distal humerus in a 52-year-old man with a history of chronic kidney disease and renal cell carcinoma. On imaging with plain radiographs, CT, and MRI, this expansile lucent lesion with solid internal enhancement had an appearance that overlapped with metastasis or brown tumor of hyperparathyroidism. On 18F-FDG PET-CT, this lesion was hypermetabolic with an SUVmax of 9.9. Only 37 cases of solid ABC have previously been reported to involve the long bones in the literature, and only 4 in the humerus. We review the clinical, imaging, and histopathological findings and differential diagnosis of solid ABC, and highlight the usefulness of identifying the USP6 gene rearrangement on FISH to distinguish this lesion from other lesions with secondary ABC formation.
Assuntos
Braço/patologia , Cistos Ósseos Aneurismáticos/diagnóstico , Úmero/patologia , Hiperparatireoidismo/patologia , Osteíte Fibrosa Cística/patologia , Cistos Ósseos Aneurismáticos/patologia , Diagnóstico Diferencial , Pé , Mãos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteíte Fibrosa Cística/complicações , Osteíte Fibrosa Cística/diagnóstico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , RadiografiaRESUMO
BACKGROUND: Brown tumors represent a rare clinical manifestation reported in approximately 3% of patients with primary hyperparathyroidism and correspond to radiologically osteolytic lesions with well-defined borders in different parts of the skeleton. CASE PRESENTATION: We report the case of a 53-year-old white man who presented to our hospital with osteolytic lesions of his distal ulna and radius, causing pain and swelling of 2-month duration. A subsequent biopsy revealed histological features consistent with giant cell tumor and a complete resection of his distal ulna was followed, along with curettage and cementoplasty of the distal radial metaphysis. Two weeks later, he was re-admitted with diffuse musculoskeletal soreness, anorexia, constipation, nausea, and localized abdominal pain and multiple osteolytic lesions on plain radiographs. A histopathological examination of the ulna and radius specimens showed similar findings and, given the multifocality, brown tumors related to primary or secondary hyperparathyroidism was included in the differential diagnosis. A laboratory examination showed high total serum calcium (14.5 mg/dl) and low serum phosphorus and 25-hydroxyvitamin D levels. Primary hyperparathyroidism was suspected and confirmed by the elevated parathyroid hormone levels of 1453 pg/mL. At radiological work-up, using computed tomography, ultrasonography, and parathyroid subtraction technetium-99m sestamibi scintigraphy, a 4.5 × 2.5 × 3.2 cm mass emanating from the right lobe of his thyroid gland was detected, displaying extensive uptake in the right lower parathyroid gland. After appropriate medical support including hyperhydration and high doses of diuretics and diphosphonates, his laboratory profile normalized and he underwent total thyroidectomy with removal of the parathyroid glands. Our patient is now recovering 12 months after surgery, with normal values of serum parathyroid hormone and calcium levels. The lytic bone lesions have almost disappeared and no other additional orthopedic intervention was necessary. CONCLUSIONS: The present case report emphasizes the need of inclusion of brown tumors in the differential diagnosis of multifocal osteolytic bone lesions, in order to avoid harmful surgical interventions. Laboratory testing of serum phosphate, calcium levels, and parathyroid hormone levels should always be included in the routine survey of patients with multifocal osteolytic lesions.
Assuntos
Tumores de Células Gigantes , Hiperparatireoidismo Primário , Osteíte Fibrosa Cística , Neoplasias das Paratireoides , Erros de Diagnóstico , Tumores de Células Gigantes/diagnóstico , Humanos , Hiperparatireoidismo Primário/diagnóstico , Masculino , Pessoa de Meia-Idade , Osteíte Fibrosa Cística/diagnóstico , Neoplasias das Paratireoides/diagnóstico , Rádio (Anatomia) , UlnaRESUMO
Brown tumor of the jaws is a manifestation of hyperparathyroidism consisting of osteolytic lesions that show proliferation of multinucleated giant cells in the maxilla and/or mandible. Differential diagnosis of these lesions from local central giant-cell granuloma is mandatory for the correct treatment of the patient. Radiographic and histopathological exams of the jaw lesion are not sufficient to determine the diagnosis, which requires laboratory tests including serum levels of calcium, alkaline phosphatase, parathyroid hormone (PTH) and phosphate, and radiographic examination of other bones as well, such as hand-wrist, pelvis, and femur. We present here a brief literature review focusing on the clinical and radiographic features, diagnostic criteria and treatment of brown tumor and also report a case of the disease affecting the jaw.
Assuntos
Hiperparatireoidismo/diagnóstico , Doenças Mandibulares/diagnóstico , Osteíte Fibrosa Cística/diagnóstico , Corticosteroides/uso terapêutico , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Imageamento Tridimensional , Transplante de Rim , Masculino , Doenças Mandibulares/diagnóstico por imagem , Doenças Mandibulares/patologia , Osteíte Fibrosa Cística/tratamento farmacológico , Osteíte Fibrosa Cística/patologia , Tomografia Computadorizada por Raios XRESUMO
A 28-year-old Syrian refugee presented with right-sided knee pain and progressive deterioration of the general condition over the past months. Laboratory diagnostics revealed severe hypercalcemia due to primary hyperparathyroidism, and computed tomography (CT) scanning demonstrated disseminated osteolytic lesions throughout the skeleton. Histologically, these lesions were characterized by multinuclear giant cells (defining these lesions as so-called brown tumors). Finally, surgical removal of a jugular mass allowed the histopathologic diagnosis of a sporadic parathyroid carcinoma. In the patient, this condition was associated with a mutation in the HPRT2 gene locus.
Assuntos
Hipercalcemia , Hiperparatireoidismo Primário , Osteíte Fibrosa Cística , Neoplasias das Paratireoides , Refugiados , Adulto , Humanos , Hipercalcemia/complicações , Hipercalcemia/diagnóstico , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Osteíte Fibrosa Cística/diagnóstico , Osteíte Fibrosa Cística/etiologia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnósticoRESUMO
BACKGROUND: Long-term severe hyperparathyroidism leads to thinning of cortical bone and cystic bone defects referred to as osteitis fibrosa cystica. Cysts filled with hemosiderin deposits may appear colored as "brown tumors." Osteitis fibrosa cystica and brown tumors are occasionally visualized as multiple, potentially corticalis-disrupting bone lesions mimicking metastases by bone scintigraphy or 18F-fluorodeoxyglucose positron emission tomography. CASE PRESENTATION: We report a case of a 72-year-old white woman who presented with malaise, weight loss, and hypercalcemia. She had a history of breast cancer 7 years before. The practitioner, suspecting bone metastases, initiated bone scintigraphy, which showed multiple bone lesions, and referred her to our hospital for further investigations. Laboratory investigations confirmed hypercalcemia but revealed a constellation of primary hyperparathyroidism and not hypercalcemia of malignancy; in the latter condition, a suppressed rather than an increased value of parathyroid hormone would have been expected. A parathyroid adenoma was found and surgically removed. The patient's postoperative course showed a hungry bone syndrome, and brown tumors were suspected. With the background of a previous breast cancer and lytic, partly corticalis-disrupting bone lesions, there was a great concern not to miss a concomitant malignant disease. Biopsies were not diagnostic for either malignancy or brown tumor. Six months after the patient's neck surgery, imaging showed healing of the bone lesions, and bone metastases could be excluded. CONCLUSIONS: This case shows essential differential diagnosis in a patient with hypercalcemia and multiple bone lesions. Whenever multiple, fluorodeoxyglucose-avid bone lesions are found, malignancy and metabolic bone disease should both be included in the differential diagnosis. Fluorodeoxyglucose-avid and corticalis-disrupting lytic lesions also occur in benign bone disease. There may be very few similar cases with heterogeneous and widespread bone lesions reported in the literature, but we think our patient's case is particularly remarkable for its detailed imaging and the well-documented course.
Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias da Mama , Hipercalcemia/diagnóstico , Osteíte Fibrosa Cística/diagnóstico , Idoso , Neoplasias Ósseas/patologia , Cálcio/sangue , Colecalciferol/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Hipercalcemia/complicações , Hipercalcemia/terapia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Osteíte Fibrosa Cística/complicações , Osteíte Fibrosa Cística/tratamento farmacológico , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Resultado do Tratamento , Vitaminas/uso terapêuticoAssuntos
Hiperparatireoidismo Secundário/cirurgia , Doenças Maxilomandibulares/etiologia , Falência Renal Crônica/terapia , Osteíte Fibrosa Cística/etiologia , Paratireoidectomia , Diálise Peritoneal/efeitos adversos , Biópsia , Feminino , Humanos , Hiperparatireoidismo Secundário/diagnóstico , Hiperparatireoidismo Secundário/etiologia , Doenças Maxilomandibulares/diagnóstico , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Osteíte Fibrosa Cística/diagnóstico , Resultado do Tratamento , Adulto JovemRESUMO
Brown tumors are a definitive feature of hyperparathyroidism. They are well-demarcated osteolytic lesions commonly in the appendicular skeleton. Primary hyperparathyroidism is typically suggested by hypercalcemia and hypophosphatemia on routine labs. Much more rarely do these cases present with a craniofacial mass. Here we investigate a unique presentation of terminal stage primary hyperparathyroidism with a growing maxillary mass emphasizing the importance of a broad differential diagnosis and key diagnostic studies. Hyperparathyroidism can present in very unique ways. As otolaryngologists in the frontline, we must think beyond just tissue diagnoses so that appropriate and expedited care may be implemented. Laryngoscope, 127:1318-1321, 2017.