Brown Tumor of the Cervical Spines: A Case Report with Literature Review

Abstract

To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion.

Brown tumour in the cervical spine : Case report and review of literature

“…Table 1 shows the three previous cases resulting from secondary hyperparathyroidism and three due to primary hyperparathyroidism. [2] Brown tumours in the spine are a rare finding in this particular cohort of patients. Brown tumours (also known as osteitis fibrosa cystica) are associated with increased osteoclast activity that result from primary or secondary hyperparathyroidism.…”

“…Brown tumours (also known as osteitis fibrosa cystica) are associated with increased osteoclast activity that result from primary or secondary hyperparathyroidism. [1][2][3][4][5][6][7] There is a loss of the bone's trabeculae occurs as a consequence of increased osteoclast activity as well as a reactive proliferation of fibroblasts. The net result is bone of a predisposition to micro fractures and secondary haemorrhage.…”

“…Brown tumour in C2 is a rare finding and only few cases have been reported in the literature. [1,2] It has been associated with persistently raised levels of parathyroid hormone (PTH). Increased production of PTH from the parathyroid glands leads to a disruption in calcium-phosphate metabolism, causing retention of phosphate alongside a reduction in calcitriol levels.…”

“…The incidence rates of brown tumour have been reported from 1.5% to 13% in patients with end stage renal disease (ESRD). [1][2][3][4] 2. CASE HISTORY…”

Brown tumors mimicking bone and lung metastases: Key role of radionuclide imaging

“…Symptoms related to brown tumors depend on their size, their site and the nature of the adjacent structures. Bone pain, fractures and neurological deficit were described [10,11]. These lesions and related symptoms usually regress after correction of the hyperparathyroidism [9].…”