Primary hyperparathyroidism-induced brown tumors caused by parathyroid carcinoma: a case report and literature review

Abstract

Brown tumors represent a benign disease that is induced by primary or secondary hyperparathyroidism, with the pathological feature of osteitis fibrosa cystica. Primary hyperparathyroidism caused by parathyroid carcinoma resulting in brown tumors is extremely rare. Herein, we report the case of a 60-year-old male patient who was admitted for giant cell tumors of the bone with local pain and limited movement of the left knee joint. With early detection of multifocal osteolytic bone lesions, hyperparathyroidism (parathyroid hormone: 2365.00 pg/mL), and parathyroid cancer, the diagnosis of brown tumors was confirmed without any unnecessary or harmful interventions. Thereafter, he underwent parathyroidectomy, from which postoperative pathology confirmed parathyroid carcinoma, and total knee arthroplasty to restore movement of the knee joint. Seven months after surgery, the left knee joint had good range of movement. This case emphasizes that detecting patients’ parathyroid hormone levels should not be neglected when diagnosing multifocal osteolytic bone lesions. A comprehensive analysis combining clinical symptoms, imaging, and laboratory tests is conducive to accurate disease assessments and avoiding unnecessary or even survival-impairing surgery. However, when the tumor involves a large joint or seriously affects joint movement, surgery may be worth considering.

Cutaneous manifestations and treatment of arsenic toxicity: A systematic review

“…Nail changes were noted in seven studies consisting of case reports, retrospective cohort and cross‐sectional studies 14,16,17,27,34,35 . Mees' lines were consistently reported in all seven studies with Uede et al.…”

“…25,33 Nail changes were noted in seven studies consisting of case reports, retrospective cohort and crosssectional studies. 14,16,17,27,34,35 Mees' lines were consistently reported in all seven studies with Uede et al being the only study to highlight other features such as complete leukonychia, Beau's lines and onychodystrophy. 14…”

“…Zhou et al. also reported that sodium dimercaptosulfonate, a less toxic BAL salt, given as two courses of 0.25 mg oral daily for 3 days each can improve pruritus and arsenic‐induced keratoses 34 . Other case reports noted the use of 5%–10% salicylic acids in reducing hyperkeratosis suspected to be caused by chronic arsenic exposure 27,48,49 .…”

“…Avoiding further exposure is a common management of chronic arsenic toxicity in several studies. Low level evidence studies suggest that chelation therapy including dimercaprol, sodium dimercaptosulfonate and D‐penicillamine may be potential treatments 15–17,34,44 . Dimercaptosuccinic acid is also another arsenic chelator, but none of the selected studies demonstrated its use in treating arsenic toxicities for those with cutaneous presentations 17 .…”

“…17,44 Zhou et al also reported that sodium dimercaptosulfonate, a less toxic BAL salt, given as two courses of 0.25 mg oral daily for 3 days each can improve pruritus and arsenic-induced keratoses. 34 Other case reports noted the use of 5%-10% salicylic acids in reducing hyperkeratosis suspected to be caused by chronic arsenic exposure. 27,48,49 Five case reports suggested that in presentations where there may be hyperkeratosis with concurrent cutaneous malignancies, individuals may respond well with oral retinoids such as acitretin, dose ranged 10-25 mg/day, in combination with other management strategies.…”