Multiple Brown Tumors in Unsuspected Primary Hyperparathyroidism Mimicking Metastatic Disease on Radiograph and Bone Scan

Jm, Joyce; Rj, Idea; Sj, Grossman; Rg, Liss; Jb, Lyons

doi:10.1097/00003072-199407000-00016

Cited by 52 publications

(18 citation statements)

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“…[5111213171819] Joyce et al . [20] were the first who reported multiple BTs in primary hyperparathyroidism due to adenoma mimicking metastasis in 1994. In the presented case, there were two BTs which were localized: One in spine and the other in mandible.…”

Section: Discussionmentioning

confidence: 99%

Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature

et al. 2014

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Brown tumor (BT), also known as osteoclastoma, may appear in the context of primary and secondary hyperparathyroidism. Spinal cord compression due to the BT is extremely rare. We present here an unusual case of BT involving thoracal spine and mandible. A 26-year-old woman, who had been on hemodialysis for chronic renal failure for over 6 years, got admitted with dorsal pain and progressive weakness in her lower extremities and gait disturbances. Neurological examination revealed spastic paraparesis and symmetrically hyperactive tendon reflex in the lower extremities. She had hypoesthesia under T10 level. On physical examination, a swelling on the left side of her jaw was also detected. Magnetic resonance imaging (MRI) showed cord compression due to an extradural mass lesion at T8 level. A computerized tomography (CT) scan showed that this expansile lytic lesion was caused by the collapse of vertebra corpus (T8) at that level. CT of the mandible revealed an expansile lytic lesion on left arm of the mandible. Laboratory findings were nearly normal except parathormone level elevation to 1289 pg/mL (normal 30-70 pg/mL). Ultrasound examination showed enlargement of the parathyroid glands. The patient underwent an emergency decompression and stabilization surgery. The lesion was fragile and reddish in appearance and was easy to aspirate. The tumor was reported as “BT.” Her weakness in the lower extremities improved in the early postoperative period. Following surgical intervention, the patient was transferred to nephrology clinic for additional medical treatment.

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Section: Discussionmentioning

confidence: 99%

Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature

et al. 2014

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“…In fact, since 1994, when Joyce et al first reported that multiple brown tumors in primary hyperparathyroidism due to adenoma can mimic metastatic disease on MIBI scan [7], there have been many similar reports [8][9][10]. Thus, even in the presence of very high levels of Ca and intact PTH in the serum, urolithiasis and bone abnormalities with multiple destructive masses in the ribs on CT and MIBI and a palpable neck tumor, the presence of brown tumors should be considered as the differential diagnosis of metastasis of malignant parathyroid.…”

Section: Discussionmentioning

confidence: 99%

Multiple Brown Tumors in Primary Hyperparathyroidism Caused by an Adenoma Mimicking Metastatic Bone Disease with False Positive Results on Computed Tomography and Tc-99m Sestamibi Imaging: MR Findings

et al. 2007

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Abstract. We encountered an unusual case of hyperparathyroidism with both hemosiderin deposits on the ribs and low intensity on T2-weighted magnetic resonance imaging (MRI) caused by a parathyroid adenoma with multiple brown tumors that mimicked metastatic bone tumor due to false positive results on computed tomography (CT) and Tc-99m sestamibi (MIBI) imaging. The patient, a middle-aged woman, had very high serum levels of calcium (14.1 mg/dl), alkaline phosphatase (9,369 IU/l) and intact-PTH (12,400 pg/ml), and a large tumor (2.5 cm in diameter) in the lower portion of the left lobe of the thyroid. Plain X-ray revealed a soft tumor in the left chest wall. On CT scan, there were multiple destructive masses in the ribs, including large intramedullary masses on both 3rd ribs. On MIBI scintigraphy, there was strong late uptake in the lower portion of the left cervical region, both 3rd ribs, and the left 7th, 8th, and 10th ribs. T2-weighted image MRI scans showed that both 3rd ribs had a low intensity with hemosiderin deposits. These findings suggested that the patient had hyperparathyroidism with multiple bone metastases due to carcinoma of the parathyroid gland. However, on pathology, the resected tumor of lower portion of the left lobe of thyroid was diagnosed as a parathyroid adenoma, and the tumors of the left 3rd and 7th ribs, as well as the right 2nd rib, were shown to be brown tumors. After resection, the patient's serum levels of calcium, alkaline phosphatase, and intact-PTH normalized. At 1.5-years follow-up, CT, MIBI, and MRI scans showed no abnormal findings. It is necessary to determine whether MRI can be used to distinguish between brown tumors and metastases caused by carcinoma of the parathyroid gland. THE most common cause of primary hyperparathyroidism is a solitary adenoma, followed by hyperplasia and carcinoma [1]. Conventional techniques for detecting the location of abnormal parathyroid glands are associated with many difficulties and often yield false negative and false positive results. Recently, Tc-99m hexakis methoxyisobutylisonitrile (MIBI) imaging was established as the best and most convenient localization method for detecting adenoma [1], after having been first reported by Coakley et al.

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“…in 1994. [24] Also five more cases have been observed since then. Such rare and multiple benign lesions may simulate a cancer and pose a real challenge for the clinician during its differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Primary hyperparathyroidism having multiple Brown tumors mimicking malignancy

Ullah

Ahmad

Ali

et al. 2012

Indian J Endocr Metab

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Primary hyperparathyroidism is a disease characterized by excessive secretion of parathormone. During the course of this disease, bone loss occurs, particularly depending on resorption of the skeletal system. One of the complications of primary hyperparathyroidism is fibrotic, cystic bony changes which is called Brown tumor. Skeletal manifestations in the form of Brown tumors are rare and according to literature occur in less than 2% of patients suffering from any form of hyperparathyroidism. Such rare and multiple benign lesions may simulate a malignant neoplasm and pose a real challenge for the clinician in its differential diagnosis. We present a case of a 23-year-old Indian woman who was evaluated for multiple lytic expansile lesions with a strong suspicion of malignancy and fibrous dysplasia but turned out to be a case of primary hyperparathyroidism.

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Multiple Brown Tumors in Unsuspected Primary Hyperparathyroidism Mimicking Metastatic Disease on Radiograph and Bone Scan

Cited by 52 publications

References 0 publications

Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature

Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature

Multiple Brown Tumors in Primary Hyperparathyroidism Caused by an Adenoma Mimicking Metastatic Bone Disease with False Positive Results on Computed Tomography and Tc-99m Sestamibi Imaging: MR Findings

Primary hyperparathyroidism having multiple Brown tumors mimicking malignancy

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