Pathologic fracture of the distal femur in osteitis fibrosa cystica simulating metastatic disease

Abstract

A 32-year-old woman sustained a minor sliding accident with moderate to severe pain about the left distal thigh and hip and the right shoulder. Radiographs showed marked osteopenia, multiple osteolytic bone lesions, and a pathologic fracture of the left distal femur. Surgical intervention was conducted for the pathologic fracture, and the pathological findings confirmed the diagnosis of primary hyperparathyroidism with osteitis fibrosa cystica. We report this rare case here because it may be mistaken for neoplastic metastatic disease on radiographs and bone scan. The pathologic fracture usually heals and the bone mineral density improves significantly within 6 months after parathyroidectomy.

Primer Hiperparatiroidizmli Bir Hastada Klavikulanın Patolojik Kırığı Nedeniyle Meydana Gelen Brakiyal Pleksus Lezyonu

“…Elevated levels of serum calcium, alkaline phosphatase, and PTH, and decreased serum phosphate level are diagnostic indicators of PHPT, as in the present case (3,12).…”

“…Singhal et al (15) reported that 5%-15% of patients with PHPT have associated bony abnormalities. The skeletal involvement includes diffuse osteoporosis or polyostotic lytic bone lesions, which are manifested clinically by diffuse or focal bone pain, or pathologic fractures involving osteolytic bone lesions (3,4,12). Radiologic examination reveals osteopenia of the entire skeleton and multiple localized lytic lesions with a benign aspect.…”

“…Radiologic examination reveals osteopenia of the entire skeleton and multiple localized lytic lesions with a benign aspect. Subperiosteal bone resorption of the phalanges is the most sensitive radiologic sign of PHPT (2,3,11).…”

“…Low bone density and impaired bone quality predispose to pathologic fractures. Patients often require parathyroidectomy as a definitive treatment (2)(3)(4).…”

Brown Jaw Tumors: challenges and outcomes

“…The histopathology shows diffuse proliferation of the osteoclastic multinucleated giant cells mixed with fibro cellular proliferation and hemorrhagic foci, with release of hemosiderin so appears as reddish-brown mass. 5,6 However, the histopathological diagnosis feature alone cannot confirm the diagnosis because other giant cell lesions such as giant cell granuloma is similar to the lesions therefore, patients with giant cell tumors should be included in investigation for the presence or absence of hyperparathyroidism in order to differentiate these types of granuloma from brown tumors.…”