Bone metastasis is the most common diagnosis considered for lytic lesions in the bone. Parathyroid cancer presenting as overt bone disease with diffuse lytic lesions secondary to untreated hyperparathyroidism (HPT) is a rare entity nowadays. We report the case of a 50-year-old Chinese lady who presented with diffuse bone lesions consistent with Brown tumours, vertebral body collapse and hypercalcaemia mimicking bone metastasis and was later diagnosed with parathyroid cancer.
Adenocarcinoma ; Osteitis Fibrosa Cystica ; Hyperparathyroidism ; Parathyroid Neoplasms

Primary hyperparathyroidism (PHPT) typically results from parathyroid adenoma, multiglandular hyperplasia, or parathyroid carcinoma. Patients usually present with skeletal manifestations such as low-trauma fractures. Osteitis fibrosa cystica (OFC) is a classic yet rare skeletal manifestation of advanced PHPT currently reported in less than 2% of patients. We present a case of a 29-year-old Indian female who presented with a femur fracture and mandibular OFC 20 days after delivery. The painless mandibular swelling gradually progressed from the third month of pregnancy. The biochemical and radiological investigations were indicative of PHPT-associated OFC. After the excision of the three-and-a-half parathyroid gland, histology revealed benign cystic adenomas and hyperplasia. Based on the associated clinical manifestations, OFC was suspected. Clinical exome sequencing revealed CDC73(+) c.687_688dupAG heterogenous pathogenic autosomal dominant mutation. Undiagnosed PHPT in mothers during pregnancy led to neonatal hypocalcaemic convulsions. With adequate supplementation, the infant recovered completely from transient congenital hypoparathyroidism. OFC is an important diagnosis to consider in a young patient with swelling of the neck and jaw. Simultaneous high levels of PTH and serum calcium should raise a high index of suspicion for OFC. Parathyroidectomy helps manage the biochemical abnormalities and causes regression of the jaw mass that causes facial disfigurement and attenuates the declining BMD. Children born to mothers with PHPT should be evaluated for neonatal hypoparathyroidism and supplemented appropriately to reduce the risk of hypocalcaemic manifestations that can be life-threatening. If the CDC73 mutation is detected, the offspring should be monitored for signs of PHPT due to the high probability of inheritance and parathyroid malignancy.
Osteitis Fibrosa Cystica ; Hyperparathyroidism, Primary ; Fracture, Pathological ; Fractures, Spontaneous

Adult ; Bone Diseases, Developmental ; Female ; Humans ; Osteitis Fibrosa Cystica ; Temporal Bone

To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion.
Axis, Cervical Vertebra ; Bone Remodeling ; Giant Cells ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary ; Incidence ; Osteitis Fibrosa Cystica ; Spine*

Carcinoma of the parathyroid gland has been reported as a rare disease occurring in 0.5 to 4% of patients with the primary hyperparathyroidism. Brown tumor is characterized as the terminal stage of remodeling processes during the primary or secondary hyperparathyroidism. Brown tumor induced by the primary hyperparathyroidism can commonly occur in the ribs, clavicle, and pelvic bone. We experienced a case of a 29-year old female patient, who had parathyroid carcinoma leading to primary hyperparathyroidism, followed by multiple Brown tumor. We present this case of parathyroid carcinoma with Brown tumors with a brief review of literature.
Clavicle ; Female ; Humans ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary ; Osteitis Fibrosa Cystica ; Parathyroid Glands ; Parathyroid Neoplasms* ; Pelvic Bones ; Rare Diseases ; Ribs

The causes of osteolytic lesions found in radiological examinations are not quite certain. Therefore, to determine the appropriate treatment method, various approaches and analyzes are required to find the real cause. Hyperparathyroidism is one of the diseases which forms osteolytic bone lesions so-called brown tumor. A 55-year-old woman who had painful osteolytic bone lesions in both hip joint areas was diagnosed as parathyroid carcinoma after serial work-up. She underwent parathyroidectomy and follow-up imaging showed a decrease in brown tumor size and bone consolidation in the subchondral bone destruction area. Proper evaluation of osteolytic bone lesions helps to avoid unnecessary operative treatments and the first choice for the treatment of osteolytic bone lesions caused by parathyroid carcinoma is parathyroidectomy.
Female ; Follow-Up Studies ; Hip Joint ; Humans ; Hyperparathyroidism ; Methods ; Middle Aged ; Osteitis Fibrosa Cystica ; Parathyroid Neoplasms ; Parathyroidectomy

A cystic parathyroid adenoma is rare. A case of primary hyperparathyroidism, with the cystic formation of a parathyroid adenoma and a severe bony lesion, is reported. A 52-year-old male was admitted due to pain in both hips and for evaluation of hypercalcemia. The plasma level of the intact parathyroid hormone(iPTH) was elevated to 1424pg/mL. Ultrasonography and the computed tomography revealed a parathyroid cyst on the left thyroid lower pole. Parathyroid scintigraphy detected a parathyroid adenoma. A radiograph showed a subperiosteal bone resorption on the phalanges, and a brown tumor(osteitis fibrosa cystica) on the femur shaft was noted. A surgical excision of the parathyroid adenoma was performed. The PTH level in the cystic fluid was increased. A histological examination confirmed a cystic parathyroid adenoma. The PTH level was normalized after the operation.
Bone Resorption ; Femur ; Hip ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Male ; Middle Aged ; Osteitis Fibrosa Cystica ; Parathyroid Neoplasms* ; Plasma ; Radionuclide Imaging ; Thyroid Gland ; Ultrasonography

Brown tumor refers to a change of skeletones that develops as a complication of hyperparathyroidism. As osteoclast is activated to stimulate reabsorption and fibrosis of bone, it causes a cystic change of the bone. Parathyroid carcinoma is being reported as a tumor that induces primary hyperparathyroidism. It causes excessive secretion of the parathyroid hormone and increases the blood parathyroid hormone and calcium. Bone deformation due to brown tumor is known to be naturally recovered through the treatment for hyperparathyroidism. However, there is no clearly defined treatment for lesions that can induce pathological fractures developing in lower extremities. We experienced a case where brown tumor developed in the proximal femur of a 57-year-old female patient due to parathyroid carcinoma. In this case, spontaneous fracture occurred without any trauma, and it was cured by performing intramedullary nailing fixation and parathyroidectomy. We report the treatment results along with a literature review.
Calcium ; Female ; Femur* ; Fibrosis ; Fracture Fixation, Intramedullary ; Fractures, Spontaneous* ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Lower Extremity ; Middle Aged ; Osteitis Fibrosa Cystica ; Osteoclasts ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Parathyroidectomy ; Skeleton

PURPOSE: Chronic renal failure is known to occur with many disturbances in calcium metabolism including osteoporosis, bone decalcification, osteitis fibrosa cystica, and parathyroid hyperplasia. Renal transplantation may benefit the patients with chronic renal failure by reversing these disturbances, but it can also have deleterious effects on the bone. Osteoporosis remains one of the most frequent and serious complications after renal transplantation. The aim of this retrospective study is to evaluate the factors affecting osteoporosis after renal transplantation. METHODS: Bone mineral density (BMD) was measured a median 46 months (range 1~121) after renal transplantation in 118 of 274 patients between March 1991 and May 2002. At the time of bone examination, sex, age, duration of dialysis before transplantation, posttransplantation period, cumulative doses of prednisone, number of rejection, serum levels of cyclosporine, BUN, Cr, Ca, P, alkaline phosphatase (ALP), osteocalcin, urine levels of deoxypyridinoline, and cumulative doses of prednisone were measured. RESULTS: Duration between renal transplantation and BMD measurement (Ed-confirm this addition) was longer, and cumulative doses of prednisone were higher in patients whose lumbar vertebrae BMD was osteoporotic with statistical significance (P=0.023 and P=0.011, respectively). Longer duration between renal transplantation and BMD measurement and higher cumulative doses of prednisone were also seen in patients whose femoral neck BMD was osteoporotic, but without a statistical significance (P=0.186 and P=0.184, respectively). Cyclosporine level did not correlate well with either lumbar vertebrae or femoral neck BMD (P=0.800 and P=0.474). Nor did other factors show a statistically significant correlation. CONCLUSION: Our data indicated that longer duration between renal transplantation and BMD measurement and higher cumulative doses of prednisone were the statistically significant factors affecting patients with osteoporotic BMD at the lumbar vertebrae and femoral neck. To prevent osteoporosis after renal transplantation, it is important to restrict the cumulative doses of prednisone as early as possible following renal transplantation.
Alkaline Phosphatase ; Bone Density ; Calcium ; Cyclosporine ; Dialysis ; Femur Neck ; Humans ; Hyperplasia ; Kidney Failure, Chronic ; Kidney Transplantation* ; Lumbar Vertebrae ; Metabolism ; Osteitis Fibrosa Cystica ; Osteocalcin ; Osteoporosis* ; Prednisone ; Retrospective Studies

A 65-year-old man with back pain had plain radiographs that showed multiple osteolytic bone lesions of the pelvis, femur and L-spine; an magnetic resonance imaging scan of the L-spine showed extensive bony resorption with a posterior epidural mass involving the L1 spinous process; these findings suggested multiple myeloma or bony metastasis. However, all serology testing was negative. The parathyroid hormone and serum calcium levels were found to be abnormally elevated. A fine needle aspiration biopsy suggested that the L-spine lesion was consistent with the diagnosis of osteitis fibrosa cystica. A pathological fracture of the spine compressed the spinal cord, and surgical intervention was required. The neck computed tomography and Tc-99m sestamibi scan showed a solitary parathyroid mass. A minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring was performed and two enlarged parathyroid glands identified. This case illustrates the importance of the consideration of a rare brown tumor associated with primary hyperparathyroidism in patients with the bone lesions suggestive of a malignancy.
Back Pain ; Biopsy ; Biopsy, Fine-Needle ; Calcium ; Femur ; Fractures, Spontaneous ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Magnetic Resonance Imaging ; Multiple Myeloma ; Neck ; Neoplasm Metastasis ; Osteitis ; Osteitis Fibrosa Cystica ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy ; Pelvis ; Spinal Cord ; Spine