Gupta A, Horattas M C, Moattari A R, Shorten S D
Department of Surgery, Northeastern Ohio Universities College of Medicine and Akron General Medical Center, 44307, USA.
Am Surg. 2001 Oct;67(10):951-5.
Osteitis fibrosa cystica (brown tumors) can be a skeletal manifestation of advanced hyperparathyroidism, including parathyroid cancer. Severe osteitis fibrosa cystica can mimic metastatic bone diseases especially in patients with a history of cancer. Because the treatment and prognosis of these two problems differ greatly considering hyperparathyroidism in the differential diagnosis of patients found to have osteolytic lesions is critical for the appropriate management of these patients. In this case report we describe a patient with a history of renal cell cancer and presumed osteolytic bone metastases. During prophylactic intramedullary rodding to prevent pathologic fracture of her femur she was found to have a benign lesion related to her previously undiagnosed hyperparathyroidism caused by an underlying parathyroid cancer. A detailed review of this disease and the associated bone changes is also included to underscore the importance of an adequate differential diagnosis as well as optimal management. Patients with hypercalcemia or bony lesions should not automatically be treated palliatively for metastatic disease just because of a past medical history of cancer. Hyperparathyroidism is a readily curable problem if properly diagnosed.
纤维囊性骨炎（棕色瘤）可能是晚期甲状旁腺功能亢进的骨骼表现，包括甲状旁腺癌。严重的纤维囊性骨炎可酷似转移性骨病，尤其是在有癌症病史的患者中。鉴于这两个问题的治疗和预后差异很大，因此在对发现有溶骨性病变的患者进行鉴别诊断时考虑甲状旁腺功能亢进对于这些患者的恰当管理至关重要。在本病例报告中，我们描述了一名有肾细胞癌病史且推测有溶骨性骨转移的患者。在预防性髓内钉固定以防止其股骨病理性骨折的过程中，发现她患有与潜在甲状旁腺癌导致的先前未诊断出的甲状旁腺功能亢进相关的良性病变。本文还对该疾病及相关骨改变进行了详细综述，以强调充分鉴别诊断以及优化管理的重要性。高钙血症或骨病变患者不应仅因过去有癌症病史就自动接受转移性疾病的姑息治疗。如果诊断正确，甲状旁腺功能亢进是一个易于治愈的问题。
