Jarrar Sultan M, Daoud Suleiman S, Jbarah Omar F, Albustami Iyad S
Neurosurgery, Department of Clinical Neuroscience, Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030, 22110, Irbid, Jordan.
Ann Med Surg (Lond). 2021 Feb 27;63:102197. doi: 10.1016/j.amsu.2021.102197. eCollection 2021 Mar.
Brown tumor (BT) is defined as osteolytic lesion of an underlying state of hyperparathyroidism. Hyperparathyroidism will activate osteoclasts which initiate active bone resorption foci of lytic-cysts with hemosiderin depositions that pigment it with its characteristic brown pathologic gross appearance. Devastating fractures and injuries can occur to affected bones and surrounding tissue that require emergent intervention and correction.
We present a case of a medically free 31-year-old female patient, who presented complaining of unsteadiness and progressive lower limbs weakness over 40 days of duration. Subsequent lab tests showed elevated PTH levels, along with 3.5 × 1.8 cm heterogeneous soft tissue mass involving the right pedicle on T7 level compressing the corresponding level of the spinal cord. Surgical management aimed to decompress the spinal cord and to obtain a biopsy for histopathologic examination which revealed a brown tumor. Neck ultrasound and Sestamibi scan indicated the presence of hyperactive and hyperplastic parathyroid tissue most suggestive of parathyroid adenoma.
Various presentations of Brown Tumor depend on the bone affected, despite the rarity of spinal involvement, yet expanding tumors can manifest either with back pain, radicular pain, paresthesia, weakness, paralysis, or incontinence. The highest incidence rates of spinal brown tumors affect adults over the age of 40. Management goals are to decompress the neuronal tissue emergently and to prevent further bony lytic deterioration.
The objective of this study is to provide an overview of primary hyperparathyroidism-related spinal brown tumors, presentation, and summary of previously reported similar cases in the literature.
棕色瘤（BT）被定义为甲状旁腺功能亢进基础状态下的溶骨性病变。甲状旁腺功能亢进会激活破骨细胞，引发伴有含铁血黄素沉积的溶解性囊肿的活跃骨吸收灶，使其呈现出特征性的棕色病理大体外观。受影响的骨骼和周围组织可能会发生严重骨折和损伤，需要紧急干预和矫正。
我们报告一例31岁无基础疾病的女性患者，她主诉持续40多天的步态不稳和进行性下肢无力。随后的实验室检查显示甲状旁腺激素（PTH）水平升高，同时在T7水平发现一个3.5×1.8厘米的不均匀软组织肿块，累及右侧椎弓根，压迫相应节段的脊髓。手术治疗旨在解除脊髓压迫并获取活检组织进行组织病理学检查，结果显示为棕色瘤。颈部超声和甲氧基异丁基异腈（Sestamibi）扫描显示存在功能亢进和增生的甲状旁腺组织，最提示甲状旁腺腺瘤。
棕色瘤的各种表现取决于受累骨骼，尽管脊柱受累罕见，但不断增大的肿瘤可表现为背痛、神经根性疼痛、感觉异常、无力、瘫痪或尿失禁。脊柱棕色瘤的最高发病率影响40岁以上的成年人。治疗目标是紧急解除神经组织压迫并防止进一步的骨质溶解性恶化。
本研究的目的是概述原发性甲状旁腺功能亢进相关的脊柱棕色瘤、临床表现，并总结文献中先前报道的类似病例。
