Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna andradius

BACKGROUND: Brown tumors represent a rare clinical manifestation reported in approximately 3% of patients with primary hyperparathyroidism and correspond to radiologically osteolytic lesions with well-defined borders in different parts of the skeleton. CASE PRESENTATION: We report the case of a 53-...

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Κύριοι συγγραφείς: Panagopoulos, A., Tatani, I., Kourea, H. P., Kokkalis, Z.T., Panagopoulos, K., Megas, P.
Άλλοι συγγραφείς: Παναγόπουλος, Ανδρέας
Μορφή: Journal (paper)
Γλώσσα:English
Έκδοση: 2019
Θέματα:
Διαθέσιμο Online:https://doi.org/10.1186/s13256-018-1723-y
http://hdl.handle.net/10889/12155
id nemertes-10889-12155
record_format dspace
spelling nemertes-10889-121552022-09-05T11:16:40Z Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna andradius Panagopoulos, A. Tatani, I. Kourea, H. P. Kokkalis, Z.T. Panagopoulos, K. Megas, P. Παναγόπουλος, Ανδρέας Τατάνη, Ειρήνη Κουρέα, Ελένη Κόκκαλης, Ζήνων Παναγόπουλος, Κωνσταντίνος Μέγας, Παναγιώτης Brown tumor Primary hyperparathyroidism Giant cell tumor Parathyroid carcinoma BACKGROUND: Brown tumors represent a rare clinical manifestation reported in approximately 3% of patients with primary hyperparathyroidism and correspond to radiologically osteolytic lesions with well-defined borders in different parts of the skeleton. CASE PRESENTATION: We report the case of a 53-year-old white man who presented to our hospital with osteolytic lesions of his distal ulna and radius, causing pain and swelling of 2-month duration. A subsequent biopsy revealed histological features consistent with giant cell tumor and a complete resection of his distal ulna was followed, along with curettage and cementoplasty of the distal radial metaphysis. Two weeks later, he was re-admitted with diffuse musculoskeletal soreness, anorexia, constipation, nausea, and localized abdominal pain and multiple osteolytic lesions on plain radiographs. A histopathological examination of the ulna and radius specimens showed similar findings and, given the multifocality, brown tumors related to primary or secondary hyperparathyroidism was included in the differential diagnosis. A laboratory examination showed high total serum calcium (14.5 mg/dl) and low serum phosphorus and 25-hydroxyvitamin D levels. Primary hyperparathyroidism was suspected and confirmed by the elevated parathyroid hormone levels of 1453 pg/mL. At radiological work-up, using computed tomography, ultrasonography, and parathyroid subtraction technetium-99m sestamibi scintigraphy, a 4.5 × 2.5 × 3.2 cm mass emanating from the right lobe of his thyroid gland was detected, displaying extensive uptake in the right lower parathyroid gland. After appropriate medical support including hyperhydration and high doses of diuretics and diphosphonates, his laboratory profile normalized and he underwent total thyroidectomy with removal of the parathyroid glands. Our patient is now recovering 12 months after surgery, with normal values of serum parathyroid hormone and calcium levels. The lytic bone lesions have almost disappeared and no other additional orthopedic intervention was necessary. CONCLUSIONS: The present case report emphasizes the need of inclusion of brown tumors in the differential diagnosis of multifocal osteolytic bone lesions, in order to avoid harmful surgical interventions. Laboratory testing of serum phosphate, calcium levels, and parathyroid hormone levels should always be included in the routine survey of patients with multifocal osteolytic lesions. 2019-05-24T05:36:37Z 2019-05-24T05:36:37Z 2018-01 Journal (paper) Panagopoulos, A. et. al. (2018). Osteolytic lesions (Brown Tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna andradius. Journal of Medical Case Reports, 12 (1), 176. https://doi.org/10.1186/s13256-018-1723-y https://doi.org/10.1186/s13256-018-1723-y http://hdl.handle.net/10889/12155 en application/pdf Journal of Medical Case Reports
institution UPatras
collection Nemertes
language English
topic Brown tumor
Primary hyperparathyroidism
Giant cell tumor
Parathyroid carcinoma
spellingShingle Brown tumor
Primary hyperparathyroidism
Giant cell tumor
Parathyroid carcinoma
Panagopoulos, A.
Tatani, I.
Kourea, H. P.
Kokkalis, Z.T.
Panagopoulos, K.
Megas, P.
Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna andradius
description BACKGROUND: Brown tumors represent a rare clinical manifestation reported in approximately 3% of patients with primary hyperparathyroidism and correspond to radiologically osteolytic lesions with well-defined borders in different parts of the skeleton. CASE PRESENTATION: We report the case of a 53-year-old white man who presented to our hospital with osteolytic lesions of his distal ulna and radius, causing pain and swelling of 2-month duration. A subsequent biopsy revealed histological features consistent with giant cell tumor and a complete resection of his distal ulna was followed, along with curettage and cementoplasty of the distal radial metaphysis. Two weeks later, he was re-admitted with diffuse musculoskeletal soreness, anorexia, constipation, nausea, and localized abdominal pain and multiple osteolytic lesions on plain radiographs. A histopathological examination of the ulna and radius specimens showed similar findings and, given the multifocality, brown tumors related to primary or secondary hyperparathyroidism was included in the differential diagnosis. A laboratory examination showed high total serum calcium (14.5 mg/dl) and low serum phosphorus and 25-hydroxyvitamin D levels. Primary hyperparathyroidism was suspected and confirmed by the elevated parathyroid hormone levels of 1453 pg/mL. At radiological work-up, using computed tomography, ultrasonography, and parathyroid subtraction technetium-99m sestamibi scintigraphy, a 4.5 × 2.5 × 3.2 cm mass emanating from the right lobe of his thyroid gland was detected, displaying extensive uptake in the right lower parathyroid gland. After appropriate medical support including hyperhydration and high doses of diuretics and diphosphonates, his laboratory profile normalized and he underwent total thyroidectomy with removal of the parathyroid glands. Our patient is now recovering 12 months after surgery, with normal values of serum parathyroid hormone and calcium levels. The lytic bone lesions have almost disappeared and no other additional orthopedic intervention was necessary. CONCLUSIONS: The present case report emphasizes the need of inclusion of brown tumors in the differential diagnosis of multifocal osteolytic bone lesions, in order to avoid harmful surgical interventions. Laboratory testing of serum phosphate, calcium levels, and parathyroid hormone levels should always be included in the routine survey of patients with multifocal osteolytic lesions.
author2 Παναγόπουλος, Ανδρέας
author_facet Παναγόπουλος, Ανδρέας
Panagopoulos, A.
Tatani, I.
Kourea, H. P.
Kokkalis, Z.T.
Panagopoulos, K.
Megas, P.
format Journal (paper)
author Panagopoulos, A.
Tatani, I.
Kourea, H. P.
Kokkalis, Z.T.
Panagopoulos, K.
Megas, P.
author_sort Panagopoulos, A.
title Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna andradius
title_short Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna andradius
title_full Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna andradius
title_fullStr Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna andradius
title_full_unstemmed Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna andradius
title_sort osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna andradius
publishDate 2019
url https://doi.org/10.1186/s13256-018-1723-y
http://hdl.handle.net/10889/12155
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