Osteitis Fibrosa Cystica Mistaken for Malignant Disease

Abstract

A 65-year-old man with back pain had plain radiographs that showed multiple osteolytic bone lesions of the pelvis, femur and L-spine; an magnetic resonance imaging scan of the L-spine showed extensive bony resorption with a posterior epidural mass involving the L1 spinous process; these findings suggested multiple myeloma or bony metastasis. However, all serology testing was negative. The parathyroid hormone and serum calcium levels were found to be abnormally elevated. A fine needle aspiration biopsy suggested that the L-spine lesion was consistent with the diagnosis of osteitis fibrosa cystica. A pathological fracture of the spine compressed the spinal cord, and surgical intervention was required. The neck computed tomography and Tc-99m sestamibi scan showed a solitary parathyroid mass. A minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring was performed and two enlarged parathyroid glands identified. This case illustrates the importance of the consideration of a rare brown tumor associated with primary hyperparathyroidism in patients with the bone lesions suggestive of a malignancy.

Osteolytic lesions: osteitis fibrosa cystica in the setting of severe primary hyperparathyroidism

“…OFC typically presents with bone pain, skeletal abnormalities and pathological fractures, especially of long bones, along with general features of hypercalcaemia 5. The radiological sequelae include diffuse osteopaenia, osteolytic lesions, pathological long bone fractures and resorption of terminal phalanges 5–7…”

Multiple Brown Tumors and Pathologic Patellar Fracture in a Patient With Secondary Hyperparathyroidism

“…Hyperparathyroidism is the overactivity of the parathyroid glands resulting in excess production of PTH. [1][2][3][4][5] Hyperparathyroidism can be primary, secondary, or tertiary and, when left untreated, can escalate into abnormal bone metabolism, resorption leading to demineralization and increased porosity of bone, fractures, and Brown tumors. 2 Primary HPT is caused by parathyroid adenomas in 85% of cases, leading to hyperplasia and oversecretion of PTH.…”

“…Brown tumors, also known as osteitis fibrosa cystica, are not true neoplasms but rather focal lytic lesions caused by excessive osteoclastic activity in the setting of HPT. [3][4][5][6][7][8] These lesions are named for the microhemorrhage that leads to n radiologic case study hemosiderin deposition within the Brown tumor, resulting in the characteristic reddishbrown color. 1,2 Brown tumors are most commonly found in the cortical region of bones, where bone resorption due to HPT is at its highest.…”

“…1,2 Brown tumors are most commonly found in the cortical region of bones, where bone resorption due to HPT is at its highest. 5 imaging Radiographs detected a nondisplaced pathologic fracture through the left patella, lytic expansile remodeling of both patellae, multiple lytic lesions throughout both tibiae, and extensive vascular calcifications attributed to atherosclerosis accelerated by renal failure (Figure 1). Brown tumors are classically lytic with well-defined borders on radiographs or CT (Figures 1-2), although healing lesions will demonstrate various levels of sclerosis.…”

Osteitis fibrosa cystica masquerading as bone neoplasm

“…Osteitis fibrosa cystica (OFC) or brown tumour is a collection of osteoclasts and poorly woven bone which has been described in association with severe hyperparathyroidism 2. Due to its radiographic and histological appearance, it is often mistaken for metastatic disease or bone neoplasms 3. Although not seen commonly, it may be the presenting manifestation of hyperparathyroidism.…”