scholarly journals Brown tumor due to primary hyperparathyroidism resulting in acute paraparesis: Case report and literature review

2020 ◽  
Vol 11 ◽  
pp. 355
Author(s):  
Ahmed Taha Elsayed Shaaban ◽  
Mostafa Ibrahem ◽  
Ahmed Saleh ◽  
Abdulrazzaq Haider ◽  
Abdulnasser Alyafai
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bone Lesion ◽  
Excisional Biopsy ◽  
Brown Tumor ◽  
Parathyroid Tumor ◽  
Osteitis Fibrosa Cystica ◽  
Lytic Bone Lesion ◽  
Brown Tumors ◽  
Acute Paraparesis ◽  
Operative Decompression

Background: Brown tumor (Osteoclastoma) is a rare benign, focal, lytic bone lesion most commonly attributed to a parathyroid adenoma; it occurs in approximately 5% of patients with primary hyperparathyroidism, and 13% of patients with secondary hyperparathyroidism. Most tumors are located in the mandible, pelvis, ribs, and large bones; only rarely is it found in the axial spine. Case Description: A 37-year-old male with primary hyperparathyroidism presented with an MR-documented T4 and T5 brown tumor (Osteitis Fibrosa Cystica) resulting in an acute paraparesis. The patient successfully underwent excisional biopsy of an expansile, enhancing, bony destructive lesion at the T4-5 level. Subsequently, he required subtotal excision of a left upper parathyroid tumor. Conclusion: Patient with primary hyperparathyroidism may acutely present with paraparesis attributed to brown tumors of the spine warranting emergent operative decompression.

scholarly journals A Reference Finding Rarely Seen in Primary Hyperparathyroidism: Brown Tumor

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
F. Mantar ◽  
S. Gunduz ◽  
U. R. Gunduz
Keyword(s):  
Bone Loss ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Male Patient ◽  
Surgical Procedures ◽  
Bone Disease ◽  
Bone Lesion ◽  
Brown Tumor ◽  
Osteitis Fibrosa Cystica ◽  
Localized Form

Primary hyperparathyroidism is an endocrinopathy which is characterized with the hypersecretion of parathormone. During the progress of the disease bone loss takes place due to resorption on the subperiosteal and endosteal surfaces. Brown tumor is a localized form of osteitis fibrosa cystica, being part of the hyperparathyroid bone disease. It is rarely the first symptom of hyperparathyroidism. Nowadays, the diagnosis is made at an asymptomatic or minimally symptomatic stage. We present a male patient presented with a massive painless swelling in the left maxilla as the first manifestation of primary hyperparathyroidism due to a parathyroid adenoma. Parathyroidectomy was performed, and there was a regression of the bone lesion, without the need of performing other local surgical procedures.

scholarly journals SAT-364 Brown Tumor of the Mandible in Severe Uncontrolled Primary Hyperparathyroidism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Suruchi K Gupta ◽  
Runhua Hou ◽  
Harold Rosen
Keyword(s):  
Primary Hyperparathyroidism ◽  
Ct Scan ◽  
The United States ◽  
Osteitis Fibrosa ◽  
Brown Tumor ◽  
Osteitis Fibrosa Cystica ◽  
Hypercalcemia Of Malignancy ◽  
Brown Tumors ◽  
The Right ◽  
Pth Level

Abstract Background: Brown tumors are a part of the complex “osteitis fibrosa cystica” which is a diffuse resorptive process of the bone resulting from uncontrolled hyperparathyroidism. Although these brown tumors were fairly common in the past1, the incidence of brown tumors is now extremely rare in the United States due to early diagnosis and treatment of hyperparathyroidism. Here we describe an unusual presentation for osteitis fibrosa cystica. Clinical Case: A 38 year old woman was admitted to the hospital with rapidly growing facial swelling in June 2019. The swelling initially appeared in January 2019 and had rapidly increased in size since April 2019. The mass was malodorous, painful and interfered with oral intake. The patient smoked 1 pack per day for 13 years. A CT scan of the head and neck with contrast showed a 3.6 x 4.5 x 3.3 cm mass destroying the right mandibular body, involving the right platysma muscle and displacing the central and lateral incisor teeth and was concerning for malignancy. The initial impression was that this was likely a squamous cell carcinoma with local and perhaps distant metastases, complicated by humoral hypercalcemia of malignancy and she was admitted for management. Upon admission, her calcium level was 14 mg/dL, albumin 4.1 g/dL, phosphorus 1.4 mg/dL PTH level was 890 pg/mL and vitamin D level was 22 ng/mL. Since the high PTH did not fit with hypercalcemia of malignancy, further evaluation was undertaken. A thyroid ultrasound showed a 4.6 x 1.8 x 1.5 cm isoechoic, heterogeneous lesion in the left lower pole, and Tc-99 sestamibi scan suggested parathyroid origin. The biopsy of the mouth lesion showed fibro histiocytic proliferation with multiple giant cells, negative for malignancy and consistent with a brown tumor. CT scan of the chest, abdomen and pelvis did not reveal any other masses or lytic lesions. . A skeletal survey showed another 2 cm lytic lesion in the proximal left humeral metaphysis which was not biopsied. On parathyroidectomy, the patient was found to have an enlarged left inferior parathyroid gland measuring 3.3 x 3.0 x 0.8 cm weighing 7.093 grams. Intraoperatively PTH level decreased from 890 pg/mL to 69 pg/mL. Her calcium levels returned to normal post-operatively and she was discharged home. Pathologic examination report revealed the mass to be a parathyroid adenoma. The patient reports a reduction in the size of her mandible mass since the surgery. Conclusion: Although uncommon, brown tumors can be seen in uncontrolled primary hyperparathyroidism. The mandible is a common site, though, as in this case, it is less common for it to be the only site affected Reference: 1. Rosenberg, E. H. (1962). Hyperparathyroidism. A review of 220 proved cases with special emphasis on findings in the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 15(2), 84–94.

scholarly journals Multiple Brown Tumors in a Normocalcemic Patient with Primary Hyperparathyroidism - A Case Report

2019 ◽  
Vol 22 (1) ◽  
pp. 68-72
Author(s):  
Nazmun Nahar ◽  
Nasim Khan ◽  
Ratan Kumar Chakraborty ◽  
Shakila Zaman Rima ◽  
Nadiruzzaman ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Malignant Disease ◽  
Bone Lesion ◽  
Direct Result ◽  
Initial Symptom ◽  
Brown Tumor ◽  
Bony Tissue ◽  
Benign Bone Lesion ◽  
Brown Tumors ◽  
Real Challenge

Brown tumor is a benign bone lesion that arises as a direct result of parathyroid hormone on bony tissue in some patients with hyperparathyroidism. Multiple brown tumors may simulate malignant disease and it is a real challenge for the clinicians in the differential diagnoses. Brown tumor as the only and initial symptom of normocalcemic primary hyperparathyroidism is a rare clinical entity. Here, we present a case with multiple brown tumors in a young normocalcemic woman as a sequele of primary hyperparathyroidism mimicking bone metastases. Bangladesh J. Nuclear Med. 22(1): 68-72, Jan 2019

scholarly journals Sphenoid Brown Tumor Associated with a Parathyroid Carcinoma

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Abelardo Loya-Solís ◽  
Alejandra Mendoza-García ◽  
Luis Ceceñas-Falcón ◽  
René Rodríguez-Gutiérrez
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Bone Lesion ◽  
Bone Lesions ◽  
Brown Tumor ◽  
Diagnostic Challenge ◽  
Histopathology Result ◽  
History Of ◽  
Persistent Hyperparathyroidism ◽  
Brown Tumors

Brown tumors are osteolytic bone lesions that occur as a result of persistent hyperparathyroidism. They usually appear late in the natural history of the disease and are currently very rare due to an earlier diagnosis of primary hyperparathyroidism. We present the case of a 53-year-old female with a 2-month history of bitemporal hemianopsia and diplopia. A computed tomography showed an osteolytic bone lesion that involved the sphenoid corpus and clivus. A biopsy was made and the histopathology result was consistent with a brown tumor. The aforementioned location is very infrequent to such tumors, and therefore represented a diagnostic challenge. However, in this case, its association to primary hyperparathyroidism was the clue for the diagnosis. The association of a brown tumor secondary to a parathyroid carcinoma has been seldom reported. This case represents, to our knowledge, one of the few brown tumors described in such location and the first secondary to a parathyroid carcinoma.

Giant parathyroid adenoma diagnosed by brown tumor, a clinical manifestation of primary hyperparathyroidism: a case report

2021 ◽  
pp. 1-8
Author(s):  
Banu Yigit ◽  
Mert Tanal ◽  
Bulent Citgez
Keyword(s):  
Case Report ◽  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Benign Lesion ◽  
Brown Tumor ◽  
Skeletal System ◽  
Radiological Findings ◽  
Facial Bones ◽  
Osteitis Fibrosa Cystica

Abstract Brown tumor (BT) is the pathological expression of osteitis fibrosa cystica owing to primary and secondary hyperparathyroidism (HPT). It is a rare benign lesion of skeletal system that usually affects the facial bones, clavicles, ribs, pelvis and extremities. The purpose of this case report is to present the clinical, pathological and radiological findings of BT, rarely seen in adults, originating from the giant parathyroid adenoma and emerging as the first clinical sign of HPT. The patient underwent a successful parathyroidectomy operation and on the first postoperative day, the patient was discharged without any complications. Continuous...

scholarly journals Maxillary and Frontal Bone Simultaneously Involved in Brown Tumor due to Secondary Hyperparathyroidism in a Hemodialysis Patient

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Suheil Artul ◽  
Abdalla Bowirrat ◽  
Mustafa Yassin ◽  
Zaher Armaly
Keyword(s):  
Renal Failure ◽  
Differential Diagnosis ◽  
Primary Hyperparathyroidism ◽  
Hemodialysis Patient ◽  
Frontal Bone ◽  
Brown Tumor ◽  
Unusual Manifestation ◽  
Brown Tumors ◽  
Left Maxillary Sinus ◽  
End Stage

Brown tumors are rare focal giant cell lesions of the bone caused by primary hyperparathyroidism (HPT). Brown tumor was reported in 1891; it presents as the end-stage findings of HPT. Common involvements are skull and pelvic girdle. We describe a case of 46-year-old female hemodialysis patient, with secondary HPT in whom multiple masses lesions of the left maxillary sinus and frontal bone were radiologically suspected to be brown tumor. This unusual manifestation of secondary HPT can be expected to occur with increased longevity of patients with renal failure and illustrates the need to include brown tumor in the differential diagnosis.

scholarly journals Brown tumor of the jaw after pregnancy and lactation in a MEN1 patient

2016 ◽  
Vol 2016 ◽  
Author(s):  
Anna Casteràs ◽  
Lídia Darder ◽  
Carles Zafon ◽  
Juan Antonio Hueto ◽  
Margarita Alberola ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Primary Hyperparathyroidism ◽  
Bone Mineral ◽  
Parathyroid Glands ◽  
Brown Tumor ◽  
Mineral Density ◽  
Men 1 ◽  
Pregnancy And Lactation ◽  
Brown Tumors

Summary Skeletal manifestations of primary hyperparathyroidism (pHPT) include brown tumors (BT), which are osteoclastic focal lesions often localized in the jaws. Brown tumors are a rare manifestation of pHTP in Europe and USA; however, they are frequent in developing countries, probably related to vitamin D deficiency and longer duration and severity of disease. In the majority of cases, the removal of the parathyroid adenoma is enough for the bone to remineralize, but other cases require surgery. Hyperparathyroidism in MEN1 develops early, and is multiglandular and the timing of surgery remains questionable. To our knowledge, there are no reports of BT in MEN 1 patients. We present a 29-year-old woman with MEN 1 who developed a brown tumor of the jaw 24 months after getting pregnant, while breastfeeding. Serum corrected calcium remained under 2.7 during gestation, and at that point reached a maximum of 2.82 mmol/L. Concomitant PTH was 196 pg/mL, vitamin D 13.7 ng/mL and alkaline phosphatase 150 IU/L. Bone mineral density showed osteopenia on spine and femoral neck (both T-scores = −1.6). Total parathyroidectomy was performed within two weeks, with a failed glandular graft autotransplantation, leading to permanent hypoparathyroidism. Two months after removal of parathyroid glands, the jaw tumor did not shrink; thus, finally it was successfully excised. We hypothesize that higher vitamin D and mineral requirements during maternity may have triggered an accelerated bone resorption followed by appearance of the jaw BT. We suggest to treat pHPT before planning a pregnancy in MEN1 women or otherwise supplement with vitamin D, although this approach may precipitate severe hypercalcemia. Learning points: Brown tumors of the jaw can develop in MEN 1 patients with primary hyperparathyroidism at a young age (less than 30 years). Pregnancy and lactation might trigger brown tumors by increasing mineral and vitamin D requirements. Early parathyroidectomy is advisable in MEN 1 patients with primary hyperparathyroidism, at least before planning a pregnancy. Standard bone mineral density does not correlate with the risk of appearance of a brown tumor. Removal of parathyroid glands does not always lead to the shrinkage of the brown tumor, and surgical excision may be necessary.

scholarly journals When primary hyperparathyroidism comes as good news

2020 ◽  
Vol 2020 ◽  
Author(s):  
Daniela Gallo ◽  
Sara Rosetti ◽  
Ilaria Marcon ◽  
Elisabetta Armiraglio ◽  
Antonina Parafioriti ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Bone Lesion ◽  
Imaging Study ◽  
Good News ◽  
List Type ◽  
Brown Tumors ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Summary Brown tumors are osteoclastic, benign lesions characterized by fibrotic stroma, intense vascularization and multinucleated giant cells. They are the terminal expression of the bone remodelling process occurring in advanced hyperparathyroidism. Nowadays, due to earlier diagnosis, primary hyperparathyroidism keeps few of the classical manifestations and brown tumors are definitely unexpected. Thus, it may happen that they are misdiagnosed as primary or metastatic bone cancer. Besides bone imaging, endocrine evaluation including measurement of serum parathyroid hormone and calcium (Ca) levels supports the pathologist to address the diagnosis. Herein, a case of multiple large brown tumors misdiagnosed as a non-treatable osteosarcoma is described, with special regards to diagnostic work-up. After selective parathyroidectomy, treatment with denosumab was initiated and a regular follow-up was established. The central role of multidisciplinary approach involving pathologist, endocrinologist and oncologist in the diagnostic and therapeutic work-up is reported. In our opinion, the discussion of this case would be functional especially for clinicians and pathologists not used to the differential diagnosis in uncommon bone disorders. Learning points: Brown tumors develop during the remodelling process of bone in advanced and long-lasting primary or secondary hyperparathyroidism. Although rare, they should be considered during the challenging diagnostic work-up of giant cell lesions. Coexistence of high parathyroid hormone levels and hypercalcemia in primary hyperparathyroidism is crucial for the diagnosis. A detailed imaging study includes bone X-ray, bone scintiscan and total body CT; to rule out bone malignancy, evaluation of bone lesion biopsy should include immunostaining for neoplastic markers as H3G34W and Ki67 index. If primary hyperparathyroidism is confirmed, selective parathyroidectomy is the first-line treatment. In advanced bone disease, treatment with denosumab should be considered, ensuring a strict control of Ca levels.

scholarly journals BROWN TUMOR OF BONE AS INITIAL MANIFESTATION OF PRIMARY HYPERPARATHYROIDISM

2016 ◽  
Vol 2 ◽  
pp. 38-42
Author(s):  
Sergiy Cherenko ◽  
Victoriia Hoperiia ◽  
Hennadii Bandura
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Digestive Tract ◽  
Clinical Diagnosis ◽  
Clinical Picture ◽  
Brown Tumor ◽  
Initial Manifestation ◽  
Rare Manifestation ◽  
Brown Tumors

Primary hyperparathyroidism (PHPT) is characterized with primary hyperproduction of parathyroid hormone (PTH) by affected parathyroid glands and with a corresponding increase in concentration of extracellular calcium. Long-term development of PHPT through decades leads to calcium-related symptoms and distinct changes in the skeleton, kidneys, digestive tract and other organs. In the clinical picture of PHPT, granulomatous pseudo-tumors in bones are observed as a rare manifestation of the disease – these lesions, which could imitate malignancy, are called «brown tumors». The present publication that goes into details about a clinical diagnosis, in which a brown tumor became the primary manifestation of PHPT, may be useful for physicians across various fields.

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