Brown Tumors Secondary to Parathyroid Carcinoma Masquerading as Skeletal Metastases on 18F-FDG PET/CT: A Case Report

Tsushima, Yumiko; Sun, Simeng; Via, Michael A.

doi:10.4158/accr-2018-0633

Cited by 8 publications

(7 citation statements)

References 13 publications

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“…2-deoxy-2-(fluorine-18) Fluor-D-glucose positron emission tomography ( 18 F-FDG PET) /CT was not considered appropriate, in fact, according to literature, it is not useful in differentiating metastasis from brown tumors because both have an increased signal uptake. [15] …”

Section: Discussionmentioning

confidence: 99%

A patient with multiple brown tumors due to secondary hyperparathyroidism: A case report

Bernetti¹,

Garipoli²,

Giordano³

et al. 2021

Radiology Case Reports

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Brown tumor is an uncommon non-neoplastic radiolucent bone lesion due to a rapid bone loss replaced by haemorrhage and reparative granulation tissue. It is a manifestation of hyperparathyroidism related to the high level of parathyroid hormone and represents a problem linked to the adherence to therapy. We present a case of a 44 years-old Caucasian female with hemodialysis-dependent chronic kidney disease in poor sanitary condition with CT evidence of innumerable and widespread bone tumors. At first, we considered these bone lesions strongly suspicious for metastasis, so we recommended an oncological consultation and laboratory studies, that showed a secondary hyperparathyroidism with elevated serum parathormone level of 923 pg/mL (normal range: 10-70 pg/mL). According to our experience, in case of radiological evidence of multiple bone lesions, a correct medical history is mandatory. When the patient has a history of chronic kidney disease and dialysis and high blood levels of parathyroid hormone are present, secondary hyperparathyroidism should always be considered in the differential diagnosis.

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Section: Discussionmentioning

confidence: 99%

A patient with multiple brown tumors due to secondary hyperparathyroidism: A case report

Bernetti¹,

Garipoli²,

Giordano³

et al. 2021

Radiology Case Reports

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“…Single-photon emission computed tomography (SPECT) tracers include 99 mTc-sestamibi or 99 mTc-tetrofosmin for parathyroid localization, while PET tracers include 11 C-methionine (11C-MET), 18 Ffluorodeoxyglucose ( 18 F-FDG), 18 F-fluorocholine ( 18 F-FCH), or 18 F-sodium fluoride ( 18 F-NaF). The 99 mTc-Sestamibi SPECT and 11 C-MET PET/CT are being highlighted as the most common tracers used for the detection of parathyroid adenomas [83][84][85].…”

Section: Radiological Imagingmentioning

confidence: 99%

Brown Tumour in Chronic Kidney Disease: Revisiting an Old Disease with a New Perspective

Santoso

Empitu

Kadariswantiningsih

et al. 2023

Cancers

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Osteitis fibrosa cystica (OFC) and Brown Tumours are two related but distinct types of bone lesions that result from the overactivity of osteoclasts and are most often associated with chronic kidney disease (CKD). Despite their potential consequences, these conditions are poorly understood because of their rare prevalence and variability in their clinical manifestation. Canonically, OFC and Brown Tumours are caused by secondary hyperparathyroidism in CKD. Recent literature showed that multiple factors, such as hyperactivation of the renin–angiotensin–aldosterone system and chronic inflammation, may also contribute to the occurrence of these diseases through osteoclast activation. Moreover, hotspot KRAS mutations were identified in these lesions, placing them in the spectrum of RAS–MAPK-driven neoplasms, which were until recently thought to be reactive lesions. Some risk factors contributed to the occurrence of OFC and Brown Tumours, such as age, gender, comorbidities, and certain medications. The diagnosis of OFC and Brown Tumours includes clinical symptoms involving chronic bone pain and laboratory findings of hyperparathyroidism. In radiological imaging, the X-ray and Computed tomography (CT) scan could show lytic or multi-lobular cystic alterations. Histologically, both lesions are characterized by clustered osteoclasts in a fibrotic hemorrhagic background. Based on the latest understanding of the mechanism of OFC, this review elaborates on the manifestation, diagnosis, and available therapies that can be leveraged to prevent the occurrence of OFC and Brown Tumours.

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“…Метастазы в костях иногда трудно отличить от фиброзно-кистозного остеита вследствие гиперпаратиреоза. ПЭТ-КТ с 18 F-ФДГ и ОФЭКТ с 99m Tc-MIBI не позволяют дифференцировать эти два состояния, так как эти радиофармпрепараты накапливаются и в метастатических очагах, и в очагах фиброзно-кистозного остеита [22,23]. Подозрение на метастаз должно возникнуть при повышении уровня кальция и ПТГ в крови.…”

Section: Note Hte -Hemithyroidectomy; Lnd -Lymph Node Dissection; Ptunclassified

Parathyroid carcinoma. The experience of treatment of 15 patients and a review

Северская

Ильин

Chebotareva

et al. 2020

Opuholi golovy i šei

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Background. Parathyroid cancer (PC) is extremely rare, usually diagnosed after surgery, there are no clinical recommendations for the treatment of metastatic PC.The study objective is to present the results of a clinical examination and treatment of patients with PC.Materials and methods. Retrospective analysis of 15 PC patients treated from 2001 to 2019. The results of laboratory tests, the surgical approach, the results of treatment, the rate of metastasis and relapse within 19 months (3 months – 11.6 years) after surgery are presented.Results. Tumor size is 35 mm (20–45 mm). Lymph node metastases – 1 (6.7 %), distant metastases – 2 (13 %). The median initial parathyroid hormone (PTH) is 735 pg/mL, calcium 3.22 mmol/L. Severe hyperparathyroidism with osteitis fibrosa cystica – in 6 (40 %). The surgical approach was parathyroidectomy in 10 (67 %), en bloc resection in 5 (33 %). Normalization of PTH and calcium after surgery – 13 (87 %). In two patients with distant metastases, the PTH and calcium remained high. A patient with Th6 vertebral metastasis was successfully operated on, with normalization of PTH and calcium, and 1.5 years was without relapse. A patient with lung and liver metastases received sorafenib after surgery, with decrease in calcium level. She died of progression 12 months after operation. Among patients with normalization of postoperative PTH, one had local relapse after 4 years. The patient was re-operated and 1 year after the second operation without relapse. The remaining patients are without relapse/progression.Conclusion. At the time of diagnosis, lymph node metastases are in 6.7 %, distant metastases – 13 %. Normalization of PTH and calcium after surgery suggests a good prognosis, but does not exclude the recurrence in the future, which requires long-term follow-up. Repeated surgery for local recurrence or solitary distant metastases can provide stable remission. Sorafenib in metastatic PC has managed to control hypercalcemia in the short term, however, antitumor efficacy requires further study.

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Brown Tumors Secondary to Parathyroid Carcinoma Masquerading as Skeletal Metastases on 18F-FDG PET/CT: A Case Report

Cited by 8 publications

References 13 publications

A patient with multiple brown tumors due to secondary hyperparathyroidism: A case report

A patient with multiple brown tumors due to secondary hyperparathyroidism: A case report

Brown Tumour in Chronic Kidney Disease: Revisiting an Old Disease with a New Perspective

Parathyroid carcinoma. The experience of treatment of 15 patients and a review

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