Gorsane Imen, Zammouri Asma, El Meddeb Jihede, Younsi Fathi, Bartkiz Ahlem, Abdelmoula Jouida, Barbouch Samia, Ben Abdallah Taieb
Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie; Laboratoire de recherche d'immunologie de transplantation rénale et d'immunopathologie (LR03SP01), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie.
Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie.
Nephrol Ther. 2016 Apr;12(2):86-93. doi: 10.1016/j.nephro.2015.09.003. Epub 2016 Feb 19.
Brown tumors are rare and severe manifestations of secondary hyperparathyroidism. We propose in this study: to define and illustrate brown tumors observed in our hemodialysis center; to show the frequency for 20 years in our center; to identify risk factors compared to the rest of dialysis patients; and finally to offer improved support for reducing the incidence.
We conducted a retrospective and descriptive study, over a period of 20 years (1993-2013), including 311 cumulative patients which are chronic hemodialysis in our unit.
Twenty-one patients had brown tumors (6.75%). The average age was 36.1 years and the sex ratio M/F is of 0.6. The average time between the start of hemodialysis and the diagnosis of brown tumor was 87.6 months. Clinical symptoms were dominated by bone pain, found in 76.1% of cases. The most frequent locations were costal (28.5% of cases), while spinal involvement was less frequent (4.76% of cases). The location was multifocal in 57.1% of cases. The mean serum calcium was of 2.08 mmol/L, the serum phosphate of 2.25 mmol/L, alkaline phosphatase of 1709 IU/L and the average value of parathyroid hormone of 1934 pg/mL. Radiography was the key of diagnostic. Resonance magnetic imaging and computed tomography had an interest in the exploration of spinal locations and maxillo-mandibular locations. All patients underwent parathyroidectomy and it was total in one patient. Tumorectomy was necessary in three patients (14.2% of cases). The outcome was favorable in 85.7% of cases.
Our work relates one of the most important series published of brown tumors and is characterized by the multifocal character of these tumors.
棕色瘤是继发性甲状旁腺功能亢进的罕见且严重表现。在本研究中，我们提议：定义并阐述在我们血液透析中心观察到的棕色瘤；展示我们中心20年来的发病频率；确定与其他透析患者相比的危险因素；最后为降低发病率提供更好的支持。
我们进行了一项为期20年（1993 - 2013年）的回顾性描述性研究，纳入了我们科室311例慢性血液透析累积患者。
21例患者患有棕色瘤（6.75%）。平均年龄为36.1岁，男女比例为0.6。血液透析开始至棕色瘤诊断的平均时间为87.6个月。临床症状以骨痛为主，76.1%的病例出现该症状。最常见的部位是肋骨（28.5%的病例），而脊柱受累较少见（4.76%的病例）。57.1%的病例为多部位病变。血清钙平均为2.08 mmol/L，血清磷为2.25 mmol/L，碱性磷酸酶为1709 IU/L，甲状旁腺激素平均值为1934 pg/mL。X线摄影是诊断的关键。磁共振成像和计算机断层扫描对脊柱部位和颌面部部位的探查有帮助。所有患者均接受了甲状旁腺切除术，其中1例为全切。3例患者（14.2%的病例）需要进行肿瘤切除术。85.7%的病例预后良好。
我们的研究涉及已发表的关于棕色瘤的最重要系列之一，这些肿瘤具有多灶性特点。
