Priyanthan Thavathurai, Hermann Anne Pernille, Bojsen Jonas Asgaard, Krøigaard Anne Bruun, Bistrup Claus, Pedersen Erik Bo
Department of Nephrology, Odense University Hospital, Odense, Denmark.
Department of Endocrinology, Odense University Hospital, Odense, Denmark.
Case Rep Nephrol. 2022 Mar 7;2022:4675041. doi: 10.1155/2022/4675041. eCollection 2022.
Brown tumors (BTs) are manifestations of osteitis fibrosa cystica that develops due to increased osteoclast activity secondary to hyperparathyroidism (HPTH). The name comes from its characteristic brown color due to high hemosiderin level and hemorrhage surrounded by osteoclastic giant cells, fibrous tissue, and bone fragments. Presentation can be either unifocal or rarely multifocal. Misdiagnosis of BT compared to malignant giant cell tumor is not uncommon. Early diagnosis and intervention may prevent destructive bone changes. Treatment of BTs due to chronic renal failure should be aimed primarily at its prevention with phosphate binders, vitamin D (analogues), calcimimetics, and prolonged dialysis sessions. Parathyroidectomy can be the option in nonresponsive cases. In this report, we present an unusual case of multiple brown tumors in a 54-year-old female renal transplant patient involving the spine, jaw, and scapula, initially misdiagnosed as giant cell tumor. Five years later, the patient was diagnosed with BT because of the medical history, morphology, and negative p63 staining in combination with secondary/tertiary hyperparathyroidism. The patient subsequently underwent subtotal parathyroidectomy.
棕色瘤（BTs）是纤维囊性骨炎的表现，其因甲状旁腺功能亢进症（HPTH）继发破骨细胞活性增加而发展。该名称源于其特征性的棕色，这是由于高含铁血黄素水平以及破骨细胞巨细胞、纤维组织和骨碎片周围的出血所致。表现可为单灶性，罕见多灶性。与恶性巨细胞瘤相比，棕色瘤的误诊并不少见。早期诊断和干预可预防骨质破坏改变。因慢性肾衰竭导致的棕色瘤治疗应主要旨在通过使用磷酸盐结合剂、维生素D（类似物）、拟钙剂和延长透析疗程来预防。在无反应的病例中，甲状旁腺切除术可作为选择。在本报告中，我们呈现了一例不寻常的病例，一名54岁女性肾移植患者出现多个棕色瘤，累及脊柱、颌骨和肩胛骨，最初被误诊为巨细胞瘤。五年后，结合病史、形态学以及p63染色阴性和继发性/三发性甲状旁腺功能亢进症，该患者被诊断为棕色瘤。患者随后接受了甲状旁腺次全切除术。
