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

Abstract

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.

Brown Tumor in Parathyroid Adenoma Mimicking Malignant Bone Tumor: A Case Report

“…These features may include areas of bone destruction (lytic lesions), cortical thinning, periosteal reaction, and soft tissue extension (Meydan et al, 2006;Parikh et al, 2021). Brown tumor mostly affects the maxilla and mandible, even though it can also affect other bones such as the shafts of long bones, the pelvis or ribs (Wasiak et al, 2020). Another cases (Meher et al, 2023;Meydan et al, 2006) had also admitted with pathologic fracture of the distal femur like ours.…”

Pathological subtrochanteric fracture revealing a primary hyperparathyroidism: A case report

“…In active individuals with large brown tumors located in the lower limbs, prophylactic fixation with intramedullary nailing can be performed. Mirels criteria can prove helpful in the relevant decision-making process [20] .…”

Osteolytic lesion of primary hyperparathyroidism masquerading as multiple myeloma: A diagnostic conundrum of multiple pathological fractures

“…The brown coloration is due to hemosiderin deposition. 2,4 It appears as a well-defined expansile osteolytic lesion with osteopenia on plain radiographs, and various bone erosion and cortical attenuation on CT while MRI imaging show hypointense on T1-weighted images, hypo-intense or hyperintense on T2-weighted images. 4,5 Brown tumor is a non-neoplastic lesion with the reported incidence in primary hyperparathyroidism of 3%.…”

“…Clinicians need to have a high suspicion of a brown tumor when their abnormal level accompanies the raised parathyroid hormone level. 2 The overactivity of the parathyroid gland can be triggered by hereditary factors, parathyroid carcinoma, parathyroid adenoma, or renal osteodystrophy. Of patients with primary hyperparathyroidism, 80-85% account for parathyroid adenoma.…”

“…1 This pathological process makes bone susceptible to fracture even with minor trauma. 2 In most instances, the clinical diagnosis of this condition is challenging and radiographic findings can be counterproductive as they often mimic features of primary bone neoplasm or metastatic bone disease. 3,4 As a consequence, the duration of illness can be quite protracted before arriving at an accurate diagnosis adding to the physical, mental, and financial burden on the patient.…”