Krishna Mohan V S, Narayan Manishi L, Mukka Arun, Bachimanchi Bharath, Chowhan Amit Kumar, Devi B Vijayalakshmi, Vaikkakara Suresh, Sachan Alok
Department of Nuclear Medicine and PET CT, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India.
Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India.
Indian J Nucl Med. 2017 Apr-Jun;32(2):133-136. doi: 10.4103/0972-3919.202234.
Brown tumors seen in hyperparathyroidism are rare, non-neoplastic lesions because of abnormal bone metabolism, and they can mimic benign bone tumors or malignancy. Although biopsy is considered as the gold standard for diagnosis, it can be inconclusive. As the diagnosis of brown tumors is often challenging, a high index of suspicion is essential for diagnosis. We present a case of 21-year-old woman who presented with multiple painful bony lesions, which were initially misdiagnosed as fibrous dysplasia. Due to persistent bone pain and deterioration in her physical mobility, she was referred to tertiary care centre. After thorough clinical workup, she underwent Tc-99m methylene diphosphonate bone scintigraphy that raised strong clinical suspicion of hyperparathyroidism and brown tumors. Subsequently, Tc-99m-methoxy isobutyl isonitrile (MIBI) parathyroid scintigraphy revealed a solitary MIBI avid focal lesion, suggestive of left inferior parathyroid adenoma. Later parathyroidectomy was performed and histopathological examination confirmed it as atypical parathyroid adenoma.
甲状旁腺功能亢进症中出现的棕色瘤是由于骨代谢异常导致的罕见非肿瘤性病变，它们可能类似良性骨肿瘤或恶性肿瘤。尽管活检被认为是诊断的金标准，但结果可能不明确。由于棕色瘤的诊断往往具有挑战性，高度的怀疑指数对诊断至关重要。我们报告一例21岁女性病例，该患者出现多处疼痛性骨病变，最初被误诊为骨纤维发育不良。由于持续的骨痛和身体活动能力下降，她被转诊至三级医疗中心。经过全面的临床检查后，她接受了锝-99m亚甲基二膦酸盐骨闪烁显像，这引起了对甲状旁腺功能亢进症和棕色瘤的强烈临床怀疑。随后，锝-99m-甲氧基异丁基异腈（MIBI）甲状旁腺闪烁显像显示一个孤立的MIBI摄取灶，提示左下方甲状旁腺腺瘤。后来进行了甲状旁腺切除术，组织病理学检查证实为非典型甲状旁腺腺瘤。
