Wiederkehr Michael
Department of Internal Medicine, Texas A&M Health Science Center, College of Medicine, Baylor University Medical Center, Dallas, TX, USA.
Clin Nephrol Case Stud. 2020 Oct 12;8:72-79. doi: 10.5414/CNCS110195. eCollection 2020.
Longstanding, severe hyperparathyroidism (HPT) can lead to the formation of "brown tumors". A brown tumor is a radiolucent bone lesion that is locally destructive; it is not a neoplasm, but rather a stromal mass consisting of fibrous tissue, poorly mineralized woven bone, and supporting vasculature. These tumors are a rare complication of advanced primary or secondary HPT. We present a young female with chronic kidney disease (CKD) on hemodialysis with uncontrolled secondary HPT (SHPT). The patient presented with progressive lower extremity weakness and back pain. CT imaging showed multiple lytic bone lesions involving several ribs and the spine. Subsequent MRI imaging of the thoracic and lumbar spine confirmed expansile bone lesions consistent with brown tumors. One mass protruded into the spinal canal causing severe stenosis at T3 with underlying cord edema. The other lesion at T12 caused only moderate spinal canal stenosis. Our patient underwent urgent neurosurgical resection of the tumor at T3 followed by subtotal parathyroidectomy (PTX).
长期的严重甲状旁腺功能亢进症（HPT）可导致“棕色瘤”的形成。棕色瘤是一种具有局部破坏性的透光性骨病变；它不是肿瘤，而是由纤维组织、矿化不良的编织骨和支持血管组成的基质肿块。这些肿瘤是晚期原发性或继发性HPT的罕见并发症。我们报告一名接受血液透析的慢性肾脏病（CKD）年轻女性，其继发性甲状旁腺功能亢进症（SHPT）未得到控制。该患者出现进行性下肢无力和背痛。CT成像显示多个溶骨性骨病变，累及多根肋骨和脊柱。随后对胸腰椎进行的MRI成像证实了与棕色瘤一致的膨胀性骨病变。一个肿块突入椎管，导致T3处严重狭窄并伴有脊髓水肿。T12处的另一个病变仅导致中度椎管狭窄。我们的患者接受了T3处肿瘤的紧急神经外科切除，随后进行了甲状旁腺次全切除术（PTX）。
