Campuzano-Zuluaga Germán, Velasco-Pérez William, Marín-Zuluaga Juan Ignacio
Department of Internal Medicine, Hospital Pablo Tobón Uribe Calle 78B No. 69-240, Medellín Colombia.
J Med Case Rep. 2009 Aug 4;3:7285. doi: 10.4076/1752-1947-3-7285.
Brown tumors are a rare focal manifestation of osteitis fibrosa cystica, which results from hyperparathyroidism. Chronic kidney failure may lead to secondary or tertiary hyperparathyroidism and thus to osteitis fibrosa cystica and brown tumors.
A 60-year-old man with a history of diabetes mellitus and chronic kidney failure presented with a 15-day history of dyspnea, cough, malaise and fever. Initially, there was little correlation between his history and his physical examination. Various pulmonary, cardiac and infectious etiologies were ruled out. A chest X-ray showed a costal mass that was further verified by tomography and gammagraphy. The mass was suspected of being neoplastic. After a failed biopsy, the mass was removed surgically and on histopathology was compatible with a giant-cell tumor versus a brown tumor caused by hyperparathyroidism. Laboratory tests showed elevated calcium, phosphate and parathyroid hormone concentrations. The patient was diagnosed with a brown tumor secondary to refractory hyperparathyroidism.
Tending towards a diagnosis because it is more frequent or it implies more risk for the patient may delay the consideration of other diagnostic options that, although rare, fit well into the clinical context. The patient presented here was suspected to have an osseous neoplasia that would have had major implications for the patient. However, reassessment of the case led to the diagnosis of a brown tumor. Brown tumors should be an important diagnostic consideration in patients with chronic kidney failure who have secondary or tertiary hyperparathyroidism and an osseous mass.
棕色瘤是纤维囊性骨炎的一种罕见局灶性表现，由甲状旁腺功能亢进引起。慢性肾衰竭可能导致继发性或三发性甲状旁腺功能亢进，进而导致纤维囊性骨炎和棕色瘤。
一名60岁男性，有糖尿病和慢性肾衰竭病史，出现呼吸困难、咳嗽、不适和发热15天。最初，其病史与体格检查之间几乎没有关联。各种肺部、心脏和感染性病因均被排除。胸部X线显示一个肋骨肿物，经断层扫描和γ射线照相进一步证实。该肿物怀疑为肿瘤性。活检失败后，肿物被手术切除，组织病理学检查结果与巨细胞瘤或甲状旁腺功能亢进引起的棕色瘤相符。实验室检查显示钙、磷和甲状旁腺激素浓度升高。该患者被诊断为继发性难治性甲状旁腺功能亢进所致的棕色瘤。
倾向于因某种诊断更常见或对患者意味着更多风险而做出该诊断，可能会延迟对其他诊断选项的考虑，这些选项虽然罕见，但与临床情况非常相符。此处介绍的患者最初被怀疑患有骨肿瘤，这对患者会有重大影响。然而，对该病例的重新评估导致诊断为棕色瘤。对于患有继发性或三发性甲状旁腺功能亢进且有骨肿物的慢性肾衰竭患者，棕色瘤应作为重要的诊断考虑因素。
