Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Brown Tumor of the Thoracic Spine : First Manifestation of Primary Hyperparathyroidism

  • Sonmez, Erkin (Department of Neurosurgery, Baskent University School of Medicine) ;
  • Tezcaner, Tugan (Department of General Surgery, Baskent University School of Medicine) ;
  • Coven, Ilker (Department of Neurosurgery, Baskent University Konya Training and Research Hospital) ;
  • Terzi, Aysen (Department of Pathology, Baskent University School of Medicine)
  • Received : 2014.10.29
  • Accepted : 2015.03.23
  • Published : 2015.10.28
Download PDF
⟨ Previous Next ⟩

Abstract

Brown tumors also called as osteoclastomas, are rare nonneoplastic lesions that arise in the setting of primary or secondary hyperparathyroidism. Parathyroid adenomas or hyperplasia constitute the major Brown tumor source in primary hyperparathyroidism while chronic renal failure is the leading cause in secondary hyperparathyroidism. Most of the patients with the diagnosis of primary hyperparathyroidism present with kidney stones or isolated hypercalcemia. However, nearly one third of patients are asymptomatic and hypercalcemia is found incidentally. Skeletal involvement such as generalized osteopenia, bone resorption, bone cysts and Brown tumors are seen on the late phase of hyperparathyroidism. The symptoms include axial pain, radiculopathy, myelopathy and myeloradiculopathy according to their locations. Plasmocytoma, lymphoma, giant cell tumors and metastates should be ruled out in the differential diagnosis of Brown tumors. Treatment of Brown tumors involve both the management of hyperparathyroidism and neural decompression. The authors report a very rare spinal Brown tumor case, arisen as the initial manifestation of primary hyperparathyroidism that leads to acute paraparesis.

Keywords

References

  1. Altan L, Kurtoglu Z, Yalcinkaya U, Aydinli U, Erturk E : Brown tumor of the sacral spine in a patient with low-back pain. Rheumatol Int 28 : 77-81, 2007 https://doi.org/10.1007/s00296-007-0380-z
  2. Daras M, Georgakopoulos T, Avdelidis D, Gravani A, Tuchman AJ : Spinal cord compression in primary hyperparathyroidism. Report of a case and review of the literature. Spine (Phila Pa 1976) 15 : 238-240, 1990 https://doi.org/10.1097/00007632-199003000-00019
  3. Fargen KM, Lin CS, Jeung JA, Yachnis AT, Jacob RP, Velat GJ : Vertebral brown tumors causing neurologic compromise. World Neurosurg 79 : 208.e1-e6, 2013
  4. Ganesh A, Kurian S, John L : Complete recovery of spinal cord compression following parathyroidectomy. Postgrad Med J 57 : 652-623, 1981 https://doi.org/10.1136/pgmj.57.672.652
  5. Haddad FH, Malkawi OM, Sharbaji AA, Jbara IF, Rihani HR : Primary hyperparathyroidism. A rare cause of spinal cord compression. Saudi Med J 28 : 783-786, 2007
  6. Hoshi M, Takami M, Kajikawa M, Teramura K, Okamoto T, Yanagida I, et al. : A case of multiple skeletal lesions of brown tumors, mimicking carcinoma metastases. Arch Orthop Trauma Surg 128 : 149-154, 2008 https://doi.org/10.1007/s00402-007-0312-0
  7. Kashkari S, Kelly TR, Bethem D, Pepe RG : Osteitis fibrosa cystica (brown tumor) of the spine with cord compression : report of a case with needle aspiration biopsy findings. Diagn Cytopathol 6 : 349-353, 1990 https://doi.org/10.1002/dc.2840060512
  8. Khalatbari MR, Moharamzad Y : Brown tumor of the spine in patients with primary hyperparathyroidism. Spine (Phila Pa 1976) 39 : E1073-E1079, 2014 https://doi.org/10.1097/BRS.0000000000000455
  9. Khalil PN, Heining SM, Huss R, Ihrler S, Siebeck M, Hallfeldt K, et al. : Natural history and surgical treatment of brown tumor lesions at various sites in refractory primary hyperparathyroidism. Eur J Med Res 12 : 222-230, 2007
  10. Lee JH, Chung SM, Kim HS : Osteitis fibrosa cystica mistaken for malignant disease. Clin Exp Otorhinolaryngol 6 : 110-113, 2013 https://doi.org/10.3342/ceo.2013.6.2.110
  11. Marcocci C, Cianferotti L, Cetani F : Bone disease in primary hyperparathyrodism. Ther Adv Musculoskelet Dis 4 : 357-368, 2012 https://doi.org/10.1177/1759720X12441869
  12. Motateanu M, Deruaz JP, Fankhauser H : Spinal tumour due to primary hyperparathyroidism causing sciatica : case report. Neuroradiology 36 : 134-136, 1994 https://doi.org/10.1007/BF00588079
  13. Mustonen AO, Kiuru MJ, Stahls A, Bohling T, Kivioja A, Koskinen SK : Radicular lower extremity pain as the first symptom of primary hyperparathyroidism. Skeletal Radiol 33 : 467-472, 2004
  14. Sarda AK, Arunabh, Vijayaraghavan M, Kapur M : Paraplegia due to osteitis fibrosa secondary to primary hyperparathyroidism : report of a case. Surg Today 23 : 1003-1005, 1993 https://doi.org/10.1007/BF00308978
  15. Shaw MT, Davies M : Primary hyperparathyroidism presenting as spinal cord compression. Br Med J 4 : 230-231, 1968 https://doi.org/10.1136/bmj.4.5625.230
  16. Shuangshoti S, Hongsaprabhas C, Chandraprasert S, Rajatapiti B : Parathyroid adenoma, brown tumor and cauda equina compression. J Med Assoc Thai 55 : 251-258, 1972
  17. Siu K, Sundaram M, Schultz C, Kirwan L : Primary hyperparathyroidism presenting as spinal cord compression : report of a case. Aust N Z J Surg 47 : 668-672, 1977 https://doi.org/10.1111/j.1445-2197.1977.tb06601.x
  18. Sundaram M, Scholz C : Primary hyperparathyroidism presenting with acute paraplegia. AJR Am J Roentgenol 128 : 674-676, 1977 https://doi.org/10.2214/ajr.128.4.674
  19. Tayfun H, Metin O, Hakan S, Zafer B, Vardar AF : Brown tumor as an unusual but preventable cause of spinal cord compression : case report and review of the literature. Asian J Neurosurg 9 : 40-44, 2014 https://doi.org/10.4103/1793-5482.131074
  20. Yokota N, Kuribayashi T, Nagamine M, Tanaka M, Matsukura S, Wakisaka S : Paraplegia caused by brown tumor in primary hyperparathyroidism. Case report. J Neurosurg 71 : 446-448, 1989 https://doi.org/10.3171/jns.1989.71.3.0446

Cited by

  1. Management of brown tumor of spine with primary hyperparathyroidism : A case report and literature review vol.98, pp.14, 2015, https://doi.org/10.1097/md.0000000000015007
  2. Brown tumor of the thoracic spine presenting with paraplegia in a patient with peritoneal dialysis vol.8, pp.4, 2019, https://doi.org/10.1007/s13730-019-00398-0
  3. Brown tumor due to primary hyperparathyroidism resulting in acute paraparesis: Case report and literature review vol.11, pp.None, 2020, https://doi.org/10.25259/sni_653_2020
  4. Brown tumor causing thoracic compressive myelopathy: A case report and review of literature vol.4, pp.2, 2021, https://doi.org/10.4103/isj.isj_48_20