Department of Nuclear Medicine, Beijing Luhe Hospital, Capital Medical University, Xinhua Road 82, Tong Zhou District, Beijing, 101149, China.
Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Xinhua Road 82, Tong Zhou District, Beijing, 101149, China.
Skeletal Radiol. 2023 Dec;52(12):2505-2511. doi: 10.1007/s00256-023-04361-0. Epub 2023 May 25.
Although parathyroid bone disease is rarely seen nowadays, skeletal manifestation can be the first sign of hyperparathyroidism (HPT) in some clinical practice. Nevertheless, the diagnosis of HPT is often overlooked. We describe three cases of multiple brown tumors (BT) in which bone pain and destruction were the first symptoms that masqueraded as a malignancy. However, according to the results of bone scan and targeted single-photon emission computed tomography/computed tomography (SPECT/CT), we considered BTs as the diagnosis in all of three cases. The final diagnoses were confirmed by laboratory tests and post-parathyroidectomy pathology. Parathyroid hormone (PTH) is significantly elevated in primary hyperparathyroidism (PHPT) as we know. However, such elevation is virtually never seen in malignancies. Diffuse or multiple foci of tracer uptakes in the bone scan were always seen in bone metastasis, multiple myeloma, and other bone neoplasm. When patients visited nuclear medicine for first consultation without biochemical results, radiological evidence from planar bone scan and targeted SPECT/CT can help in distinguishing the skeletal diseases. Lytic bone lesions with sclerosis, intra-focal or ectopic ossification and calcification, fluid-fluid level, and distribution of the lesions may be helpful in the differential diagnosis in these reported cases. In conclusion, when patients present with multiple foci of uptake on bone scan, targeted SPECT/CT is acquired for suspicious lesions, which can increase the diagnostic sensitivity and reduce unnecessary interventions and treatment. Moreover, BTs should be always kept in differential diagnosis of multiple lesions without a conclusive primary tumor.
尽管甲状旁腺骨病现在很少见，但在一些临床实践中，骨骼表现可能是甲状旁腺功能亢进症（HPT）的首发症状。然而，HPT 的诊断常常被忽视。我们描述了三例多发性棕色瘤（BT）病例，这些病例的骨痛和破坏是首先出现的症状，这些症状伪装成了恶性肿瘤。然而，根据骨扫描和靶向单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）的结果，我们考虑所有三例均为 BT 诊断。最终诊断通过实验室检查和甲状旁腺切除术后病理证实。我们知道，在原发性甲状旁腺功能亢进症（PHPT）中，甲状旁腺激素（PTH）显著升高。然而，这种升高在恶性肿瘤中几乎从未见过。在骨转移、多发性骨髓瘤和其他骨肿瘤中，骨扫描总是显示弥漫性或多发性病灶示踪剂摄取。当患者在没有生化结果的情况下首次就诊于核医学科时，平面骨扫描和靶向 SPECT/CT 的影像学证据有助于区分骨骼疾病。溶骨性骨病变伴硬化、病灶内或异位骨化和钙化、液-液水平以及病变的分布可能有助于这些病例的鉴别诊断。总之，当患者的骨扫描显示多个病灶摄取时，应针对可疑病变进行靶向 SPECT/CT 检查，这可以提高诊断敏感性并减少不必要的干预和治疗。此外，在没有明确的原发性肿瘤的情况下，应始终将 BT 作为多发性病变的鉴别诊断之一。
