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Yong Jin Cho, M.D., Ph.D.
, Yung Min Cho, M.D., Seung Min Na, M.D.*, Sung-Taek Jung, M.D., Ph.D.*
, Yung Min Cho, M.D., Seung Min Na, M.D.*, Sung-Taek Jung, M.D., Ph.D.*
Abstract
Purpose
Brown tumor is a tumor-like disease that can occur as a linked disease of hyperparathyroidism which can causes osteoporosis, osteitis fibrosa cystica, pathologic fractures. Brown tumor has been reported as a case report, but there is no comprehensive report on the exact diagnosis and principle of management for osseous lesion. The purpose of this study is to report the treatment and results of osseous lesions through 5 cases.
Materials and Methods
From February 2004 to May 2015, five cases of Brown tumor were diagnosed in Chosun University Hospital and Chonnam National University Hospital orthopedic department. Medical records and radiographs were reviewed retrospectively. Parathyroid tumors were surgically removed, and surgical treatment and observation were performed for orthopedic osseous lesions.
Results
The mean length of the long axis of the symptomatic osseous lesion was 6.2 cm (4.5–9.0 cm). An average of 7.6 (range, 3 to 14) of high uptake osseous lesion showed in whole body bone scan. The absolute value, T-score and Z-score of the vertebrae and proximal femur were adequate for diagnosis of osteoporosis using dual energy X-ray absorptiometry bone mineral density at diagnosis and recovered to normal at the last follow-up. In laboratory tests, serum concentrations of total calcium, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, and parathyroid hormone were helpful to diagnosis and normalized upon successful removal of parathyroid adenoma or cancer.
Conclusion
For accurate diagnosis of Brown tumor, it should be accompanied by systemic examination as well as clinical symptoms, laboratory tests and radiologic examination for osseous lesions. And a good prognosis can be expected if the hyperparathyroidism is treated together with the comprehensive treatment of osseous lesions.
Figures and Tables
Figure 1
A 28-year-old male who visited Chonnam National University Hospital with left shoulder pain as he fell off his bed (case 1). (A) Plain radiograph showed a cystic lesion with fracture in the left humeral shaft. (B) The presence of hemosiderin deposition and fibrous stroma explains the low intensity on T2-weighted magnetic resonance imaging. (C) A multifocal hot uptaked bony lesions and fractured left humerus were observed at whole body bone scan. (D) Both hip plain radiography performed before parathyroidectomy showed geographic pattern osteolytic bone lesions in both acetabulum, right proximal femur, left femur shaft. (E) Flexible intramedullary nailing for left humeus shaft pathologic fracture and right parathyroidectomy for parathyroid adenoma were performed. (F) In the areas of bone resorption, the replacing fibroblastic tissue contains numerous osteoclast-like giant cells (H&E, ×200). (G) On the both hip plain radiograph for 4 years after surgery, osteolytic osseous lesion were remodeled.
Notes
References
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