The pathology femoral peritrochanteric fracture with multiple brown tumor as a first sign of parathyroid cancer – A case report

Abstract

Introduction and importanceThe parathyroid cancer is sometime only diagnosed after a pathological fracture has occurred, and pathology fracture is often misdiagnosed as a malignancy tumor. The treatment for pathology fracture and multiple bone lesions is not defined.Case presentationWe report a 41-year-old case of parathyroid carcinoma in which pathological femoral fracture and brown tumors are the first clinical signs of the disease and that masqueraded as a malignancy tumor. The treatment for the patient was parathyroidectomy and then surgical treatment of the right femur with a locking plate osteosynthesis. Four months post-operative, the patient reported no pain and became capable of walking without a crutch. X-rays showed full bone union at fracture site of right femur, and brown tumors regression seen to be taking place in the upper limb, lower limbs and pelvis.Clinical discussionA brown tumor was diagnosed by a high concentration of blood parathyroid hormone and serum calcium. Despite the lack of clinical guidelines, most authors agreed that parathyroidectomy was the first choice of treatment then orthopaedic treatment. The principles of osteosynthesis of fracture were based on stable osteosynthesis. It was reported that osteolytic lesions caused by brown tumor were recovered when hyperparathyroidism had been treated.ConclusionBrown tumor needs to be considered in the differential diagnosis when there are osteolytic lesions and high serum calcium. It is advisable to have a parathyroidectomy and then orthopaedic treatment. Brown tumor with Mirels' score less than 7 scores should be applied a conservative treatment.