Brown tumor of the thoracic spine presenting with paraplegia in a patient with peritoneal dialysis

Abstract

Secondary and tertiary hyperparathyroidism is an important problem of chronic kidney disease. Brown tumor is a benign, unusual, reactive lesion as a result of disturbed bone remodeling, from long-standing increase in parathyroid hormone level. Brown tumors may cause morbidity due to pressure symptoms on neural structures and spontaneous bone fractures. Herein, we presented a peritoneal dialysis patient with tertiary hyperparathyroidism under calcand calcitriol treatment for 4 years due to refusing of the parathyroidectomy operation. She admitted to hospital for sudden onset back pain with difficulty in gait and walking, and imaging studies showed an expansile mass lesion in the thoracic spine. She was operated for mass and diagnosed with brown tumor. After operation, she lost the ability of walking than become paraplegic and she underwent rehabilitation program. Preventive measures including calcitriol and cinacalcet may cause a modest decrease in parathyroid hormone levels but it should be remembered for the development of bone complications such as brown tumor formation in patients with moderate elevated PTH levels, especially those with tertiary hyperparathyroidism. Parathyroidectomy should be performed without delay in these cases.

Mineral and bone disorder leading to a hole in jaw in a patient on peritoneal dialysis

“…Cranio-facial involvement is relatively rare [2]. There are multiple case reports on this topic in the literature [3], but his bony involvement and images were unique and represent the severity of facial bone involvement.…”

Missed C5 vertebral brown tumor causing spinal cord compression and myelopathy: A case report and literature review

“…3 Brown tumor rarely affects spinal column. To the best of our knowledge, twenty-two cases due to primary 2,4-21 and 30 cases due to secondary hyperparathyroidism 1,3,20, were reported in the literature. Among the published reports of spinal brown tumor, it mainly affected thoracic region and rarely involves cervical area.…”

“…The prevalence of brown tumor is up to 5% in primary and 13% in secondary hyperparathyroidism. 1,2 It rarely involves the spine. However, it may mimic a vertebral tumor and compress the spinal column.…”

Multiple Focal Brown Tumors (Osteitis Fibrosa Cystica) in a Renal Transplant Recipient

“…BTs have been reported in various locations such as jaw bones, ribs, and vertebrae [2,4,5]. BTs have no malignant potential; however, they can present as expansive lesions compressing surrounding structures or produce facial disfigurement [3,4,6].…”