Rheumatology Service, H. Germans Trias i Pujol, Carretera de Canyet s/n, Badalona 08916, Spain.
Clin Rheumatol. 2011 Mar;30(3):419-24. doi: 10.1007/s10067-010-1608-y. Epub 2010 Oct 28.
Brown tumors (BT) are benign focal bone lesions that may appear in the context of primary and secondary hyperparathyroidism (HPT). Involvement of the spine is exceedingly rare. We present a case of brown tumor involving the cervical spine, the third reported in the literature. In the literature review (until August 2010), we found nine cases of spinal BT in primary HPT and 14 cases in secondary HPT. Fifteen patients (65%) had evidence of spinal cord compression. A 34-year-old woman on long-term hemodialysis, with secondary HPT, presented with a 9-month history of persistent neck pain. Radiographs of the cervical spine revealed an expansive osteolytic lesion in the posterior arch of the second cervical vertebra. MR imaging revealed an expansive mass on C2 affecting the vertebral body, odontoid process, right pedicle, laminas, and spinous process; there were no signs of spinal edema. A CT-guided needle biopsy of the lesion showed destruction of trabecular bone, infiltration of the fibroblastic cells, and abundant osteoclast-like multinucleated giant cells with hemorrhage and hemosiderin pigment, and the diagnosis of brown tumor was made. Cervical pain disappeared within a few days of parathyroidectomy, and rapid remineralization of C2 was evident within a few months. BT must always be considered in the context of hyperparathyroidism and osteolytic lesions. Vertebral BT can be particularly devastating due to medullar compression symptoms. Regression or complete disappearance of these lesions after parathyroidectomy is common, but prompt surgical decompression is necessary in case of medullar compression symptoms.
棕色瘤（BT）是良性局灶性骨病变，可能出现在原发性和继发性甲状旁腺功能亢进症（HPT）的背景下。脊柱受累极为罕见。我们报告了一例颈椎棕色瘤病例，这是文献中第三次报道。在文献回顾（截至 2010 年 8 月）中，我们发现了 9 例原发性 HPT 脊柱棕色瘤和 14 例继发性 HPT 脊柱棕色瘤。15 名患者（65%）有脊髓压迫的证据。一名 34 岁的女性，长期血液透析，患有继发性 HPT，有 9 个月持续性颈部疼痛史。颈椎 X 线片显示第二颈椎后弓有一个进行性溶骨性病变。MR 成像显示 C2 上有一个膨胀性肿块，影响椎体、齿状突、右侧椎弓根、椎板和棘突；没有脊髓水肿的迹象。病变的 CT 引导下经皮穿刺活检显示，小梁骨破坏，纤维母细胞浸润，丰富的破骨细胞样多核巨细胞伴出血和含铁血黄素，诊断为棕色瘤。甲状旁腺切除术后几天内，颈部疼痛消失，C2 迅速再矿化，几个月内明显。棕色瘤必须始终在 HPT 和溶骨性病变的背景下考虑。由于有骨髓压迫症状，椎体 BT 可能特别具有破坏性。甲状旁腺切除术后这些病变常可消退或完全消失，但如果有骨髓压迫症状，应立即进行手术减压。
