Brown Tumor of Lumbar Spine in a Patient with Primary Hyperparathyroidism: Case Report

Abstract

Background Data: Brown tumor is a lytic bone tumor and has variable symptoms according to the affected site. It is called brown because of its characteristic brown color believed to have occurred after accumulation of blood, fibrous tissue, and hemosiderin. Hyperparathyroidism can result in a brown tumor whether it is primary or secondary, but this case is much rarer in primary hyperparathyroidism. It rarely affects the spine, while it is extremely rare to compromise the spinal canal. Purpose: To report a rare case of lumbar spinal brown tumor with primary hyperparathyroidism. Study Design: A case report of brown tumor of the lumbar spine (5th lumbar vertebrae). Patients and Methods: Our case was a forty-year-old female patient presenting with persistent dull aching low back pain. There was no history of any chronic illness. She had a 5-month history of slowly progressive left lower limb radicular pain and not associated with sphincter disturbance. Magnetic resonance imaging of the spine demonstrated lesion affecting the 5th lumbar vertebrae invading the left pedicle and compressing the spinal canal. Results: Team did neural decompression, biopsy harvesting, and partial corpectomy with reconstruction of the affected lumbar vertebra (L5) followed by fixation by rods and screws. The patient showed relief of the radicular pain and back pain on VAS. Histopathological analysis of the biopsy showed evidence of giant-cell tumor (brown tumor). Parathyroid survey was done and showed normal calcium levels. By revising the literature, we claim that this present study is reporting the 10th case of brown tumor of lumbar spine in patient with primary hyperparathyroidism. Conclusion: The diagnosis of brown tumor of spine could be considered in patients with lytic spine lesions. (2019ESJ192) Background Data: Brown tumor is a lytic bone tumor and has variable symptoms according to the affected site. It is called brown as its characteristic brown color that believed to be occurred after accumulation blood, fibrous tissue and hemosiderin. Hyperparathyroidism can cause it whatever it is primary or secondary. It is rarely affects the spine and extremely rare compromises the spinal canal. Purpose: To describe a case presentation of brown tumor affecting the lumbar spine. Study design: A case report of brown tumor of the lumbar spine (5th lumbar vertebrae) Patients and Methods: Our case was a forty years old female patient presenting with persistent dull aching low back pain. She had a 5 month history of slowly progressive left lower limb radicular pain and not associated with sphincter disturbance. Magnetic resonance imaging of the spine demonstrated lesion affecting the 5th lumbar vertebrae that invading the left pedicle and compressing the spinal canal. Results: Under general anesthesia, prone position, low back midline skin incision and dissection, insertion of paired poly-axial screws at the level above (L4) and level below (S1) the affected vertebra (L5) was done. The team started by anchoring the rod in-between the screws in the right side then open left transpedicular corpectomy of L5 with excision much of the lesion that was dark red suckable mild vascular tissue. Formal L5 laminectomy was done followed by insertion of transpedicular polyaxial screw on right side only of L5 and insertion of bone cement while it was semi-solid in consistency to augment preservation of the vertebral height and fusion. Neurolysis of the spinal roots and completing the fixation system were done he lesion was partially excised. The patient showed relief of the radicular pain and back pain on VAS. Conclusion: The diagnosis of brown tumor of spine could be considered in patients with slowly progressive persistent back pain.