A Brown Tumor after Biliopancreatic Diversion for Severe Obesity

Abstract

Abstract. A case of a brown tumor due to iatrogenic malabsorption following biliopancreatic diversion (BPD) is presented. A 52 year old women with a history of BPD 2 years before was referred to orthopedic surgery because of a painful lytic lesion of the left ankle. A bone biopsy revealed a giant cell tumor compatible with the diagnosis of a brown tumor. Subsequent metabolic evaluation showed severe 25-hydroxy vitamin D deficiency and secondary hyperparathyroidism (PTH 60 ng/L or twice the upper normal limit). Bone mineral density was decreased at the femoral neck (0.50 g/cm 2 ; T score of -3.92 or 66% of the expected value) and lumbar spine (T score of -1.75 or 93% of the expected value). A brown tumor can be the presenting symptom of iatrogenic malabsorption due to BPD. This case illustrates the severity of potential bone complications after BPD and the necessity of lifelong surveillance and vitamin supplements after BPD. We report an unusual case of a brown tumor, due to severe vitamin D deficiency and secondary hyperparathyroidism after biliopancreatic diversion operation (BPD) for severe obesity. Methods Tissue processing and histologyThe biopsy and currettage specimens were fixed in 6% formalin. After decalcification, the specimens were both entirely processed for paraffin embedding and staining with hematoxylin and eosin (H and E) for histopathological evaluation. No immunohistochemistry was performed. Biochemically measurementsCalcium was measured spectrophometrically (0-cresolphtalein in compexon method) and alkaline phosphatase activity was determined according to the

A haemodialysis patient with back pain: brown tumour as a cause of spinal cord compression under cinacalcet therapy

“…Our patient had severe secondary hyperparathyroidism for several years, which was refractory for medical treatment including cinacalcet. Recently, a case report described a patient who developed a brown tumour due to secondary hyperparathyroidism (PTH twice the upper normal limit) only 2 years after a biliopancreatic diversion for severe obesity [19]. Second, cinacalcet reduces PTH levels maximally 2–4 h after administration and therefore induces daily fluctuations.…”