Diamanti-Kandarakis E, Livadas S, Tseleni-Balafouta S, Lyberopoulos K, Tantalaki E, Palioura H, Giannopoulos A, Kostakis A
Endocrine Section, First Department of Medicine, Laiko General Hospital, University of Athens Medical School, 1 A Zefyrou str, Athens 145 78, Greece.
Endocrine. 2007 Dec;32(3):345-9. doi: 10.1007/s12020-008-9035-4. Epub 2008 Feb 2.
Brown tumors are erosive bony lesions caused by rapid osteoclastic activity and peritrabecular fibrosis due to hyperparathyroidism, resulting in a local destructive phenomenon. Although brown tumors are the most pathognomonic sign of hyperparathyroidism, they are very rarely observed at present as a result of early detection of hypercalcemia and elevated parathyroid hormone levels. The rare appearance of this entity in everyday practice is troublesome for both patients and physicians, because whenever it emerges, diagnosis could be mistaken for a giant cell tumor of the bone. However, clinical, biochemical, and radiologic findings can easily guide the diagnosis if one considers the full continuum of findings and their association with subject's medical history, instead of focusing only on bone lesion. In this report we present a case of brown tumor in the fibula with a short literature review, whose aggressive presentation and unawareness of the skeletal findings of hyperparathyroidism puzzled the caring doctors. This case illustrates the need for continuous vigilance of any physician, regardless of his specialty or his position in medical services structures.
棕色瘤是由甲状旁腺功能亢进导致破骨细胞快速活动和小梁周围纤维化引起的侵蚀性骨病变，会造成局部破坏现象。尽管棕色瘤是甲状旁腺功能亢进最具特征性的体征，但由于高钙血症和甲状旁腺激素水平升高的早期发现，目前很少能观察到。这种病变在日常临床中罕见的出现情况，对患者和医生来说都很棘手，因为一旦出现，其诊断可能会被误诊为骨巨细胞瘤。然而，如果综合考虑所有检查结果及其与患者病史的关联，而不是仅关注骨病变，临床、生化和影像学检查结果可以很容易地指导诊断。在本报告中，我们介绍了一例腓骨棕色瘤病例，并进行简短的文献综述，其侵袭性表现以及对甲状旁腺功能亢进骨骼表现的忽视使主治医生感到困惑。该病例表明，任何医生，无论其专业或在医疗服务机构中的职位如何，都需要持续保持警惕。
