Miwa Shinji, Tanaka Tomohiro, Aiba Hisaki, Yamada Satoshi, Otsuka Takanobu, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
Cancer Diagn Progn. 2023 Sep 3;3(5):590-596. doi: 10.21873/cdp.10259. eCollection 2023 Sep-Oct.
Brown tumor, a skeletal complication of severe hyperparathyroidism, comprises reparative granulation tissue and proliferating fibrous tissue with hemosiderin deposition. Multiple brown tumors are extremely rare complications of primary hyperparathyroidism.
A 41-year-old woman presented with pain in the left knee. Radiography showed multiple cystic lesions in both femurs and the left proximal tibia, and additional radiography showed multiple cystic lesions in the left humerus and ulna. Magnetic resonance imaging (MRI) revealed multiple cystic lesions in the bilateral femurs, left proximal tibia, and ilium. Laboratory tests revealed hypercalcemia (albumin-corrected calcium level, 13.9 mg/dl), hypophosphatemia (phosphate level, 1.6 mg/dl), elevated level of alkaline phosphatase level (614 U/l), and markedly elevated parathyroid hormone (PTH) level (1,070 pg/ml; normal range=10-65 ng/l). Tc-hexakis-2-methoxyisobutyl-isonitrile scintigraphy revealed tracer accumulation in the left upper parathyroid gland, which was consistent with parathyroid tumor. Although resection of the parathyroid tumor was planned, the patient developed parathyroid apoplexy before tumor excision. After the parathyroid apoplexy, serum calcium and PTH levels temporarily normalized. Resurgence of the PTH level was observed 2 years after the diagnosis, and the patient underwent left upper parathyroidectomy. One year after the tumor excision, the patient had no symptoms, and MRI showed shrinkage of the cystic bone lesions.
This report emphasizes the importance of considering hyperparathy-roidism as a differential diagnosis for patients with multiple bone lesions.
棕色瘤是严重甲状旁腺功能亢进的一种骨骼并发症，由修复性肉芽组织和含铁血黄素沉积的增生性纤维组织组成。多发性棕色瘤是原发性甲状旁腺功能亢进极为罕见的并发症。
一名41岁女性因左膝疼痛就诊。X线检查显示双侧股骨和左胫骨近端有多个囊性病变，进一步X线检查显示左肱骨和尺骨有多个囊性病变。磁共振成像（MRI）显示双侧股骨、左胫骨近端和髂骨有多个囊性病变。实验室检查显示高钙血症（白蛋白校正钙水平为13.9mg/dl）、低磷血症（磷酸盐水平为1.6mg/dl）、碱性磷酸酶水平升高（614U/l）以及甲状旁腺激素（PTH）水平显著升高（1070pg/ml；正常范围=10-65ng/l）。锝-六甲基异丁基异腈闪烁扫描显示左上方甲状旁腺有示踪剂积聚，与甲状旁腺肿瘤相符。尽管计划切除甲状旁腺肿瘤，但患者在肿瘤切除前发生了甲状旁腺卒中。甲状旁腺卒中后，血清钙和PTH水平暂时恢复正常。诊断后2年观察到PTH水平再次升高，患者接受了左上方甲状旁腺切除术。肿瘤切除1年后，患者无症状，MRI显示囊性骨病变缩小。
本报告强调了将甲状旁腺功能亢进作为多发性骨病变患者鉴别诊断的重要性。
