Silva Eugénia, Ferreira Rute, Lourenço Maria Helena, Marques Bernardo, Duarte Sequeira
Endocrinology, Diabetes and Metabolism, Egas Moniz Hospital, Lisbon, PRT.
Rheumatology, Egas Moniz Hospital, Lisbon, PRT.
Cureus. 2022 Nov 21;14(11):e31757. doi: 10.7759/cureus.31757. eCollection 2022 Nov.
Parathyroid carcinoma is an extremely rare endocrine neoplasm that accounts for less than 1% of the cases of primary hyperparathyroidism (PHPT). Continuous exposure to high levels of parathyroid hormone (PTH) induces an increase in bone remodeling and patients may present with osteitis fibrosa cystica, which is characterized by subperiosteal resorption of the phalanges, diffuse osteopenia, salt and pepper appearance of the skull, bone cysts, and brown tumors. Brown tumors occur in less than 5% of all patients with any form of hyperparathyroidism. Due to similar clinical, radiographic, and histological appearance, differential diagnosis of brown tumors includes primary and secondary bone tumors. We report a case of a 67-year-old female diagnosed with multiple osteolytic lesions initially thought to be bone metastasis of thyroid carcinoma. Further work-up led to the diagnosis of brown tumors due to parathyroid carcinoma. We want to emphasize the inclusion of osteitis fibrosa cystic in the differential diagnosis of osteolytic lesions and the need to perform serum calcium and PTH measurements when investigating these lesions.
甲状旁腺癌是一种极其罕见的内分泌肿瘤，在原发性甲状旁腺功能亢进症（PHPT）病例中所占比例不到1%。持续暴露于高水平的甲状旁腺激素（PTH）会导致骨重塑增加，患者可能会出现纤维囊性骨炎，其特征为指骨骨膜下吸收、弥漫性骨质减少、颅骨呈椒盐样外观、骨囊肿和棕色瘤。棕色瘤在所有任何形式甲状旁腺功能亢进症患者中的发生率不到5%。由于临床、影像学和组织学表现相似，棕色瘤的鉴别诊断包括原发性和继发性骨肿瘤。我们报告一例67岁女性病例，最初诊断为多发溶骨性病变，被认为是甲状腺癌骨转移。进一步检查后诊断为甲状旁腺癌所致棕色瘤。我们想强调在溶骨性病变的鉴别诊断中应考虑纤维囊性骨炎，并且在研究这些病变时需要检测血清钙和PTH水平。
