Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Diagnosis and Treatment of Brown Tumor

Brown 종양의 진단 및 치료

  • Cho, Yong Jin (Department of Orthopedic Surgery, Chosun University College of Medicine) ;
  • Cho, Yung Min (Department of Orthopedic Surgery, Chosun University College of Medicine) ;
  • Na, Seung Min (Department of Orthopedic Surgery, Chonnam National University College of Medicine) ;
  • Jung, Sung-Taek (Department of Orthopedic Surgery, Chonnam National University College of Medicine)
  • 조용진 (조선대학교 의과대학 정형외과학교실) ;
  • 조영민 (조선대학교 의과대학 정형외과학교실) ;
  • 나승민 (전남대학교 의과대학 정형외과학교실) ;
  • 정성택 (전남대학교 의과대학 정형외과학교실)
  • Received : 2018.12.04
  • Accepted : 2019.02.10
  • Published : 2020.02.28
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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.

목적: Brown 종양은 부갑상선 항진증으로 발생할 수 있는 종양 유사 질환으로 골다공증과 병적 골절을 일으킬 수 있다. Brown 종양에 대하여 지금까지 증례 보고로 발표되고 있으나 정확한 진단 및 골병변에 대한 치료 방침에 대한 포괄적인 보고는 없는 실정이다. 본 연구에서 저자들은 조직학적으로 증명된 다섯 증례의 Brown 종양에 대한 임상적 고찰을 통하여 진단, 치료 및 그 결과에 대해 보고하고자 한다. 대상 및 방법: 2004년 2월부터 2015년 5월까지 조선대학교병원 및 전남대학교병원 정형외과에서 Brown 종양으로 진단된 5개의 증례를 대상으로 의무 기록 및 영상 검사 등을 후향적으로 검토하였다. 치료 방법으로 전체 예에서 부갑상선 종양을 발견하여 수술적 치료를 시행하였으며, 정형외과적 병변에 대해서는 수술적 치료 및 관찰 요법을 시행하였다. 결과: 증상을 호소하는 골병변의 장축의 크기는 평균 6.2 cm (4.5-9.0 cm)였다. 전신 골주사 검사상 평균 7.6군데(3-14군데)에서 대사가 증가된 골병변이 발견되었으며, 에너지 방사선 흡수 계측법을 이용한 골밀도 검사상 척추와 근위 대퇴골에서 절대값, T-값과 Z-값이 진단 시 골다공증에 합당하다가 최종 추시 시 정상으로 회복되었다. 혈액학적 검사상 혈청 총 칼슘, 혈청 이온화 칼슘, 혈청 무기성 인, 혈청 알칼라인포스페이트, 부갑상선 호르몬 혈중 농도가 Brown 종양 진단에 도움이 되었으며, 성공적인 부갑상선 선종 또는 암 제거 시 정상화되었다. 결론: Brown 종양의 진단을 위하여는 임상 증상, 혈액학적 검사 및 골병변에 대한 영상의학적 검사의 포괄적인 이해와 분석이 필요하며, 부갑상선 기능 항진증에 대한 치료와 함께 골병변에 대해서는 그 위치와 크기, 진행 정도를 고려한 적절한 치료가 반드시 병행되어야만 한다.

Keywords

Acknowledgement

이 논문은 전남대학교병원 학술연구비(CRI10063-1)에 의하여 연구되었음.

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