Pathologic Fracture of the Femur in Brown Tumor Induced in Parathyroid Carcinoma: A Case Report

Park, Sang‐Hyun; Kong, Gyu-Min; Kwon, Yong-Uk; Park, Jun-Ho

doi:10.5371/hp.2016.28.3.173

Cited by 6 publications

(11 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In developing countries, hyperparathyroidism is mostly diagnosed lately due to lack of routine screening of serum calcium and parathyroid hormone, so pathology fracture is the first sign suggesting the disease and our case is an example. In radiological aspects, which has an osteolytic lesion at the fracture site and multiple osteolytic lesions so it is often misdiagnosed as malignant tumors, such as metastatic carcinoma, osteosarcoma, Ewing sarcoma, lymphoma and multiple myeloma [3] , [7] , [9] , [10] . In our case, there was not only a large osteolytic lesion in the right femoral peritrochanteric fracture but also multiple osteolytic lesions in the left femur, at the middle third of right femur, in the pubis, tibia, humerus and forearm.…”

Section: Discussionmentioning

confidence: 99%

The pathology femoral peritrochanteric fracture with multiple brown tumor as a first sign of parathyroid cancer – A case report

Nguyen

2021

International Journal of Surgery Case Reports

View full text Add to dashboard Cite

Introduction and importance The parathyroid cancer is sometime only diagnosed after a pathological fracture has occurred, and pathology fracture is often misdiagnosed as a malignancy tumor. The treatment for pathology fracture and multiple bone lesions is not defined. Case presentation We report a 41-year-old case of parathyroid carcinoma in which pathological femoral fracture and brown tumors are the first clinical signs of the disease and that masqueraded as a malignancy tumor. The treatment for the patient was parathyroidectomy and then surgical treatment of the right femur with a locking plate osteosynthesis. Four months post-operative, the patient reported no pain and became capable of walking without a crutch. X-rays showed full bone union at fracture site of right femur, and brown tumors regression seen to be taking place in the upper limb, lower limbs and pelvis. Clinical discussion A brown tumor was diagnosed by a high concentration of blood parathyroid hormone and serum calcium. Despite the lack of clinical guidelines, most authors agreed that parathyroidectomy was the first choice of treatment then orthopaedic treatment. The principles of osteosynthesis of fracture were based on stable osteosynthesis. It was reported that osteolytic lesions caused by brown tumor were recovered when hyperparathyroidism had been treated. Conclusion Brown tumor needs to be considered in the differential diagnosis when there are osteolytic lesions and high serum calcium. It is advisable to have a parathyroidectomy and then orthopaedic treatment. Brown tumor with Mirels' score less than 7 scores should be applied a conservative treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

The pathology femoral peritrochanteric fracture with multiple brown tumor as a first sign of parathyroid cancer – A case report

Nguyen

2021

International Journal of Surgery Case Reports

View full text Add to dashboard Cite

show abstract

“…In the meantime, the compromising of bone strength predisposes sufferers to pathological fractures. Brown tumours occurrence is notably high among women with hyperparathyroidism in their 30s and 40s [ 2 ]. Histologically, these take the form of giant cell tumours [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Brown tumours, known as osteitis fibrosa cystica, are benign osteolytic lesions of bones caused by excessive functioning of osteoclasts and hence the resorption of the mineral component from bony tissue [ 1 , 2 ]. Under microscopic examination they present a developed form of osteitis fibrosa cystica making it necessary for giant cell tumour to be precluded [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of pathological fractures due to brown tumours in a patient with hyperparathyroidism and lack of parafibromin expression – A case report

Wasiak

Popow

Bogdańska

et al. 2020

Trauma Case Reports

View full text Add to dashboard Cite

Brown tumours, known also as osteitis fibrosa cystica, are benign osteolytic lesions found in 5–15% of patients with hyperparathyroidism, and commonly located in mandibles, the shafts of long bones, the pelvis or ribs. As they compromise bone strength, pathological fractures can be a typical effect of their presence; but given the complex nature of the disease process in this case, such fractures require an interdisciplinary approach directed at orthopaedic treatment, plus management of the underlying hyperparathyroidism. In this paper, we present the case of a 36-year-old female patient with bilateral anophthalmia, hyperparathyroidism and nephrolithiasis, in whom a fall led to her sustaining a pathological fracture of the proximal third of the femoral shaft in the place of an osteolytic lesion, as well as second pathological fracture of the left patella also changed by multiple examples of such lesions. Parathyroidectomy on account of adenoma had been performed 2 weeks prior to the trauma. The femoral shaft fracture was treated surgically, the patella fracture conservatively, and a sample brown tumour was found in tissue. As the parathyroid showed no parafibromin expression, a diagnosis of HPT-JT (hyperparathyroidism and jaw tumour) was arrived at, with this condition given as caused by CDC73 mutation. This disease is able to account for brown tumours, hyperparathyroidism, benign or malignant tumours of kidneys, intestinal tract, and lungs. The approach combining treatment of the fractures with intervention over the parathyroid adenoma proved a successful one, with complete bone union ensuing, and no relapse into hyperparathyroidism 2 years on from the surgery. This case indicates the importance of an interdisciplinary approach to the treatment of brown tumours, as well as the necessity for a diagnosis to be extended when incidental brown tumours are found.

show abstract

“…To the best of our knowledge, the present case is a rare example of multiple BTs associated with parathyroid carcinoma and PHPT. Only a few similar cases have been reported in the literature [ 26 – 28 ]. Parathyroid carcinoma is one of the most rarely reported malignancies with approximately 2 new cases per 10,000,000 persons per year [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna and radius: a case report

et al. 2018

View full text Add to dashboard Cite

BackgroundBrown tumors represent a rare clinical manifestation reported in approximately 3% of patients with primary hyperparathyroidism and correspond to radiologically osteolytic lesions with well-defined borders in different parts of the skeleton.Case presentationWe report the case of a 53-year-old white man who presented to our hospital with osteolytic lesions of his distal ulna and radius, causing pain and swelling of 2-month duration. A subsequent biopsy revealed histological features consistent with giant cell tumor and a complete resection of his distal ulna was followed, along with curettage and cementoplasty of the distal radial metaphysis. Two weeks later, he was re-admitted with diffuse musculoskeletal soreness, anorexia, constipation, nausea, and localized abdominal pain and multiple osteolytic lesions on plain radiographs. A histopathological examination of the ulna and radius specimens showed similar findings and, given the multifocality, brown tumors related to primary or secondary hyperparathyroidism was included in the differential diagnosis. A laboratory examination showed high total serum calcium (14.5 mg/dl) and low serum phosphorus and 25-hydroxyvitamin D levels. Primary hyperparathyroidism was suspected and confirmed by the elevated parathyroid hormone levels of 1453 pg/mL. At radiological work-up, using computed tomography, ultrasonography, and parathyroid subtraction technetium-99m sestamibi scintigraphy, a 4.5 × 2.5 × 3.2 cm mass emanating from the right lobe of his thyroid gland was detected, displaying extensive uptake in the right lower parathyroid gland. After appropriate medical support including hyperhydration and high doses of diuretics and diphosphonates, his laboratory profile normalized and he underwent total thyroidectomy with removal of the parathyroid glands. Our patient is now recovering 12 months after surgery, with normal values of serum parathyroid hormone and calcium levels. The lytic bone lesions have almost disappeared and no other additional orthopedic intervention was necessary.ConclusionsThe present case report emphasizes the need of inclusion of brown tumors in the differential diagnosis of multifocal osteolytic bone lesions, in order to avoid harmful surgical interventions. Laboratory testing of serum phosphate, calcium levels, and parathyroid hormone levels should always be included in the routine survey of patients with multifocal osteolytic lesions.

show abstract

Pathologic Fracture of the Femur in Brown Tumor Induced in Parathyroid Carcinoma: A Case Report

Cited by 6 publications

References 9 publications

The pathology femoral peritrochanteric fracture with multiple brown tumor as a first sign of parathyroid cancer – A case report

The pathology femoral peritrochanteric fracture with multiple brown tumor as a first sign of parathyroid cancer – A case report

Treatment of pathological fractures due to brown tumours in a patient with hyperparathyroidism and lack of parafibromin expression – A case report

Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna and radius: a case report

Contact Info

Product

Resources

About