Brown Tumor of the Thoracic Spine: First Manifestation of Primary Hyperparathyroidism

Abstract

Brown tumors also called as osteoclastomas, are rare nonneoplastic lesions that arise in the setting of primary or secondary hyperparathyroidism. Parathyroid adenomas or hyperplasia constitute the major Brown tumor source in primary hyperparathyroidism while chronic renal failure is the leading cause in secondary hyperparathyroidism. Most of the patients with the diagnosis of primary hyperparathyroidism present with kidney stones or isolated hypercalcemia. However, nearly one third of patients are asymptomatic and hypercalcemia is found incidentally. Skeletal involvement such as generalized osteopenia, bone resorption, bone cysts and Brown tumors are seen on the late phase of hyperparathyroidism. The symptoms include axial pain, radiculopathy, myelopathy and myeloradiculopathy according to their locations. Plasmocytoma, lymphoma, giant cell tumors and metastates should be ruled out in the differential diagnosis of Brown tumors. Treatment of Brown tumors involve both the management of hyperparathyroidism and neural decompression. The authors report a very rare spinal Brown tumor case, arisen as the initial manifestation of primary hyperparathyroidism that leads to acute paraparesis.

Management of brown tumor of spine with primary hyperparathyroidism

“…In more severe cases, pathologic fracture, decrease in muscle strength, loss of sensation, and even paralysis can be observed due to compression of the spinal cord. [1,7,17] In our case, pathological fracture occurred in the right femur and humerus. Thoracodorsal pain and weakness of lower limbs are also found due to thoracic spine lesion.…”

“…The rest 19 studies were included for final analysis. [1,4,7,9–12,14–25] Table 1 shows the detailed features, managements, and outcomes of enrolled patients. Total 22 cases of BT of spine caused by primary hyperparathyroidism (PHPT) were published in literature: 13 females and 9 males.…”

“…On the basis of published literatures, decompressive surgery at an early stage can be effective to improve life quality apparently in relieving pain and paralysis. [1,7] In the literature, most patients underwent both spine surgery and parathyroidectomy. The outcome is, however, similar without statistical significance between patients who underwent parathyroid adenoma resection with/without spine surgery.…”

“…Brown tumor (BT) is a rare benign lesion in skeletal system due to the endocrine disorder . [1] It occurs secondary to either primary hyperparathyroidism (PHT) or secondary hyperparathyroidism (SHT). [2,3] Elevated parathyroid hormone (PTH) level results in the abnormal bone remodeling which brings about unusual reactive lesion.…”

Osseous Manifestations of Primary Hyperparathyroidism: Imaging Findings

“…MRI is the preferred diagnostic imaging modality in evaluating spinal tumor location and extension. Solitary spinal lesions have a differential diagnosis of metastases, giant cell tumor, aneurysmal bone cyst, and giant cell reparative granuloma, which can be clinically and radiographically correlated with other findings of PHPT [26]. In addition, the typical CT and MRI findings in patients with a lytic lesion and known PHPT are highly suggestive of a brown tumor diagnosis as opposed to other conditions in the differential such as multiple myeloma [24,27].…”