Diagnosis Of Brown Tumor Research Articles

Brown tumors in nuclear medicine: a systematic review

Brown tumors (BT) are abnormal bone-repair processes and a consequence of hyperparathyroidism. The diagnosis of these lytic lesions in nuclear medicine, while a challenge, is not so rare, because functional imaging is used both in the management of cancer and hyperparathyroidism. The main objective of this review is to summarize the knowledge and the evidence concerning BT and the different imaging modalities in nuclear medicine. A systematic review was performed in Embase, PubMed and Google Scholar from 2005 to 2022. We included articles describing BT in the following imaging modalities: [18F]-fluorodeoxyglucose PET/CT, [18F]-fluorocholine or [11C]-fluorocholine PET/CT, [99mTc]-Sestamibi scintigraphy, bone scan, [18F]-sodium fluoride PET/CT, [68Ga]-FAPI PET/CT; [68Ga]-DOTATATE PET/CT; [11C]-methionine PET/CT. For each modality, appearance, avidity for radiotracer, available quantitative parameters and imaging evolution after parathyroidectomy were collected and analyzed. Fifty-two articles were included for a total of 392 BT lesions. If the diagnosis of BT is evoked on a known lesion, performing a [18F]-fluorocholine PET/CT imaging seems the most appropriate. In [18F]-fluorodeoxyglucose, [18F]-fluorocholine, [18F]-sodium fluoride PET/CT and bone scan, BT can mimic metastatic disease. BT uptakes appear reversible after parathyroidectomy, with a more or less rapid decrease depending on the imaging modality used.

Primary hyperparathyroidism-induced brown tumors caused by parathyroid carcinoma: a case report and literature review

Brown tumors represent a benign disease that is induced by primary or secondary hyperparathyroidism, with the pathological feature of osteitis fibrosa cystica. Primary hyperparathyroidism caused by parathyroid carcinoma resulting in brown tumors is extremely rare. Herein, we report the case of a 60-year-old male patient who was admitted for giant cell tumors of the bone with local pain and limited movement of the left knee joint. With early detection of multifocal osteolytic bone lesions, hyperparathyroidism (parathyroid hormone: 2365.00 pg/mL), and parathyroid cancer, the diagnosis of brown tumors was confirmed without any unnecessary or harmful interventions. Thereafter, he underwent parathyroidectomy, from which postoperative pathology confirmed parathyroid carcinoma, and total knee arthroplasty to restore movement of the knee joint. Seven months after surgery, the left knee joint had good range of movement. This case emphasizes that detecting patients’ parathyroid hormone levels should not be neglected when diagnosing multifocal osteolytic bone lesions. A comprehensive analysis combining clinical symptoms, imaging, and laboratory tests is conducive to accurate disease assessments and avoiding unnecessary or even survival-impairing surgery. However, when the tumor involves a large joint or seriously affects joint movement, surgery may be worth considering.

An unusual case report: normocalcemic markers and their relationship with multiple sclerosis in primary hyperparathyroidism disease revealed by radiological markers with the diagnosis of brown tumor

BackgroundBrown tumor is a giant cell focal bone lesion associated with hyperparathyroidism and is more common in long bones such as the femur, ribs, pelvis, and clavicle, rather than in the head and neck region. Brown tumors occur less frequently in patients with primary hyperparathyroidism and are not usually a diagnostic marker of the disease. In addition, when primary hyperparathyroidism shows normocalcemic values and this disease is accompanied by multiple sclerosis, diagnosis becomes difficult.Case presentationA 57-year-old female patient presented with a painless, firm, irregularly circumscribed lesion extending from the upper palate to the nasal cavity. The lesion was first noticed by the patient about 2 months ago because it started to form asymmetry. The patient, whose anamnesis was learned to have Multiple Sclerosis (MS) and Chronic Obstructive Pulmonary Disease (COPD), was immobile. The patient was using medication only for COPD. After radiological and clinical examinations, the image in the maxilla was thought to be Brown Tumor and blood values were examined. After the incisional biopsy was also performed, it was evaluated together with the blood results and the diagnosis of brown tumor due to normocalcemic primary hyperparathyroidism was made. As in this case, brown tumor cases in which the calcium level remains within normal ranges, that is, due to Normocalcemic Hyperparathyroidism, are extremely rare, and 7 cases have been reported in the literature.ConclusionsIn the presented case, the importance of the radiological and clinical markers of the brown tumor developing due to normocalcemic hyperparathyroidism in the diagnosis is stated, the relationship of MS and the effects of the drugs used for MS at brown tumor formation is examined, and the importance of the treatment follow-up with radiological findings is stated. The features of the much rarer subgroups of relatively common diseases should be well known, and it should not be forgotten that the less frequently observed features can sometimes be the first indicator. And when large-limited lesions are identified, additional systemic features should be sought instead of direct surgical intervention.

Brown Tumor Causing Thoracic Compressive Myelopathy

Brown tumors are nonneoplastic bony lesions resulting from primary, secondary or tertiary hyperparathyroidism. Primary hyperparathyroidism is caused by parathyroid adenomas or parathyroid hyperplasia while chronic renal failure is a common cause of secondary hyperparathyroidism. Elevated parathyroid hormone levels cause increased osteoclastic activity, bone resorption and reactive fibroblastic proliferation leading to the formation of Brown tumor. Although Brown tumors are more commonly seen in the maxilla and mandible, it can occur in the long, flat bones or any bone. It is less commonly seen in the spine. In this report, we discuss the presentation, management, difficulties with histopathological diagnosis, and follow-up of a Brown tumor in a 55-year-old gentleman undergoing renal dialysis who presented with thoracic compressive myelopathy. Our patient underwent a T4 laminectomy, tumor debulking, and T2–T6 instrumented posterior fusion. Based on histopathological examination of the tissue specimen and raised serum parathyroid hormone levels, we arrived at a diagnosis of Brown tumor. Our review of the literature revealed 62 cases of vertebral Brown tumor resulting in neurologic symptoms. The lesion was more common in females (58%), those aged between 40 and 49 years (26%), and in the thoracic spine (51.6%). Early surgical intervention and management of the underlying cause of hyperparathyroidism lead to sustained symptomatic improvement. Brown tumor should be considered in the differential diagnosis of expansile vertebral lesions in the presence of hyperparathyroidism or chronic kidney disease. Treatment of the underlying hyperparathyroidism and decompression of the neural structures with or without stabilization is recommended.

BROWN TUMOR IN A PATIENT WITH PRIMARY HYPERPARATHYROIDISM: A CASE REPORT OF A LESION WITH AN UNUSUAL BEHAVIOR

A 33-year-old woman presented with a 2-year history of a large swelling on the right side of the mandible accompanied by chin paresthesia. Intra-oral examination revealed a firm enlargement beneath the normal overlying mucosa in the retromolar region. Panoramic radiograph revealed a multilocular lesion extending from the molar region to the ramus (about 15 cm). A round central radiolucent area was also noted beneath the roots of the incisor teeth. Cone beam computed tomography evaluation revealed an aggressive lesion, with rupture of the cortical plates of both sites. Biopsy revealed connective tissue with large spindle cells, with multinucleated giant cells, a large amount of blood vessels, and woven bone with osteoid deposition. Serologic tests showed altered levels of parathyroid hormone (2.377 pg/mL), alkaline phosphatase (753 U/L), and calcium (12.5 mg/dL). Final diagnosis of brown tumor of hyperparathyroidism was made, and the patient was referred to endocrinology treatment and to intralesional corticoid injection.

Primary hyperparathyroidism presenting as a brown tumor in the mandible: a case report

BackgroundPrimary hyperparathyroidism is characterized by hypercalcemia and elevated or inappropriately normal serum levels of parathyroid hormone. Brown tumor of bone is a rare non-neoplastic lesion resulted from abnormal bone metabolism in hyperparathyroidism. However, nowadays, skeletal disease caused by primary hyperparathyroidism is uncommon. We report a case of brown tumor in the mandible as the initial exhibition of primary hyperparathyroidism associated with an atypical parathyroid adenoma.Case presentationThe patient was a 49-year-old female, she had a pain mass on the right mandible a year ago and was treated with root canal therapy and marginal resection. After seven months, the mass recurred and enlarged. Enhanced CT scan, laboratory examination, Ultrasonography, 99mTc-MIBI SPECT-CT scintiscan and pathological examination were used to confirm the diagnosis of brown tumor. The patient’s symptom improved after parathyroidectomy.Conclusions99mTc-MIBI SPECT/CT scintigraphy is a highly sensitive examination of the localization diagnosis of hyperparathyroidism. Brown tumors should be considered in the differential diagnosis of osteolytic lesions to avoid unnecessary and harmful interventions.

MANDIBLE BROWN TUMOR ASSOCIATED WITH HYPERPARATHYROIDISM SECONDARY TO CHRONIC RENAL INSUFFICIENCY: CASE REPORT

Chronic renal disease decreases serum calcium level contributing to excess parathyroid hormone (PTH) synthesis. As more PTH is available, a significant change in osteoclastic activity can lead to bone focal well-defined lytic lesions known as brown tumor. We report a case of a 30-year-old female patient referred to our clinic with a chief complaint of a painful swelling of the left mandible and difficulty chewing. Her medical history included systemic lupus erythematosus, hypertension, and chronic kidney disease (was on hemodialysis for the past 9 years). Complementary computed tomography and scintigraphy examinations helped the diagnosis of brown tumor and parathyroid hyperplasia. The patient is currently undergoing dental treatment for the removal of infectious foci prior to kidney transplantation and awaits bone mineral recovery after parathyroidectomy before osteoplasty in the mandible can be surgically performed. Chronic renal disease decreases serum calcium level contributing to excess parathyroid hormone (PTH) synthesis. As more PTH is available, a significant change in osteoclastic activity can lead to bone focal well-defined lytic lesions known as brown tumor. We report a case of a 30-year-old female patient referred to our clinic with a chief complaint of a painful swelling of the left mandible and difficulty chewing. Her medical history included systemic lupus erythematosus, hypertension, and chronic kidney disease (was on hemodialysis for the past 9 years). Complementary computed tomography and scintigraphy examinations helped the diagnosis of brown tumor and parathyroid hyperplasia. The patient is currently undergoing dental treatment for the removal of infectious foci prior to kidney transplantation and awaits bone mineral recovery after parathyroidectomy before osteoplasty in the mandible can be surgically performed.

Two rare manifestations of primary hyperparathyroidism: paralysis and peptic ulcer bleeding.

Primary hyperparathyroidism revealed by thoracic spine brown tumor and peptic ulcer bleeding is rare. We presented a case of 33-year-old male patient who was admitted with paraplegia. Thoracic spine magnetic resonance imaging (MRI) showed extradural lesion at T4 level. He underwent surgical decompression in T4. According to histopathologic finding and elevated serum parathormone (PTH) and hypercalcemia (total serum calcium 12.1 mg/dL), the diagnosis of brown tumor was down. Ultrasonography of his neck showed a well-defined lesion of 26 × 14 × 6 mm. The day after surgery, he experienced 2 episodes of melena. Bedside upper gastrointestinal endoscopy showed gastric peptic ulcer with visible vessel. Treatment with intragastric local instillation of epinephrine and argon plasma coagulation was done to stop bleeding. After stabilization of the patient, parathyroidectomy was performed. Histologic study showed the parathyroid adenoma without any manifestation of malignancy. At discharge, serum calcium was normal (8.6 mg/dL). On 40th day of discharge, standing and walking status was normal.Learning points:Thoracic spine involvement is a very rare presentation of primary hyperparathyroidism.The issue of whether primary hyperparathyroidism increases the risk of peptic ulcer disease remains controversial. However, gastrointestinal involvement has been reported in association with classic severe primary hyperparathyroidism.The treatment of brown tumor varies from case to case.

Les tumeurs brunes chez les hémodialysés chroniques

PurposeBrown tumors are rare and severe manifestations of secondary hyperparathyroidism. We propose in this study: to define and illustrate brown tumors observed in our hemodialysis center; to show the frequency for 20 years in our center; to identify risk factors compared to the rest of dialysis patients; and finally to offer improved support for reducing the incidence. Patients and methodsWe conducted a retrospective and descriptive study, over a period of 20 years (1993–2013), including 311 cumulative patients which are chronic hemodialysis in our unit. ResultsTwenty-one patients had brown tumors (6.75%). The average age was 36.1 years and the sex ratio M/F is of 0.6. The average time between the start of hemodialysis and the diagnosis of brown tumor was 87.6 months. Clinical symptoms were dominated by bone pain, found in 76.1% of cases. The most frequent locations were costal (28.5% of cases), while spinal involvement was less frequent (4.76% of cases). The location was multifocal in 57.1% of cases. The mean serum calcium was of 2.08 mmol/L, the serum phosphate of 2.25 mmol/L, alkaline phosphatase of 1709 IU/L and the average value of parathyroid hormone of 1934 pg/mL. Radiography was the key of diagnostic. Resonance magnetic imaging and computed tomography had an interest in the exploration of spinal locations and maxillo-mandibular locations. All patients underwent parathyroidectomy and it was total in one patient. Tumorectomy was necessary in three patients (14.2% of cases). The outcome was favorable in 85.7% of cases. ConclusionOur work relates one of the most important series published of brown tumors and is characterized by the multifocal character of these tumors.

Normocalcemic hyperparathyroidism manifesting as brown tumor of mandible: A case report

Patients with primary hyperparathyroidism (HPT) may be asymptomatic and clinical presentation of the tumor in the jaws can be the first sign of the disease. Only 2% of all primary HPT cases occur in patients below the age of 30 years. [1] Owing to the improved methods of blood analysis in the last two decades, most of the recent cases of primary HPT are diagnosed early and asymptomatically. [2] Most cases of primary HPT are identified by hypercalcemia and hypophosphatemia on routine multi-panel serum testing. [3] This makes advanced disease with brown tumor extremely rare these days, the mandible being affected only in 4% of the cases. [2] Here, we report a case of a 23-year-old female patient who presented with a swelling at body of mandible, with hypophosphatemia, increased parathyroid hormone, and normal serum calcium levels based on which a diagnosis of brown tumor was given.

Atypical Presentation of a Brown Tumor in a Kidney Transplant Recipient: A Case Report

Brown tumor is a rare complication of secondary hyperparathyroidism. It is exceptionally encountered after kidney transplantation. We here report on a 54-year-old male recipient who developed a brown tumor localized in the right forearm, and whose initial presentation was atypical, mimicking a bone tumor. Hence, diagnosis of brown tumors should be suggested by clinicians in a context of hyperparathyroidism.

Brown tumor mimicking maxillary sinus mucocele as the first manifestation of primary hyperparathyroidism

We describe the first case of brown tumor mimicking a maxillary sinus mucocele as the first manifestation of the patient's primary hyperparathyroidism. A 34-year old woman presented with a 14 days history of elevation of the right orbit, retrobulbar pain and cheek anesthesia. The CT and MR evaluation showed a mass, initially described as mucocele of the right maxillary sinus. The laboratory studies revealed hyperparathyroidism. The patient underwent acute surgery, and the mass appeared clinically as mucocele. The histological examination of the resected lesion revealed changes representing either giant cell granuloma or brown tumor. The finding of hyperparathyroidism confirmed the diagnosis of brown tumor. To our knowledge, this is the first report of cystic brown tumor mimicking a mucocele of the maxillary sinus.

Brown tumor of the cervical spine: a case report and review of the literature

Brown tumors (BT) are benign focal bone lesions that may appear in the context of primary and secondary hyperparathyroidism (HPT). Involvement of the spine is exceedingly rare. We present a case of brown tumor involving the cervical spine, the third reported in the literature. In the literature review (until August 2010), we found nine cases of spinal BT in primary HPT and 14 cases in secondary HPT. Fifteen patients (65%) had evidence of spinal cord compression. A 34-year-old woman on long-term hemodialysis, with secondary HPT, presented with a 9-month history of persistent neck pain. Radiographs of the cervical spine revealed an expansive osteolytic lesion in the posterior arch of the second cervical vertebra. MR imaging revealed an expansive mass on C2 affecting the vertebral body, odontoid process, right pedicle, laminas, and spinous process; there were no signs of spinal edema. A CT-guided needle biopsy of the lesion showed destruction of trabecular bone, infiltration of the fibroblastic cells, and abundant osteoclast-like multinucleated giant cells with hemorrhage and hemosiderin pigment, and the diagnosis of brown tumor was made. Cervical pain disappeared within a few days of parathyroidectomy, and rapid remineralization of C2 was evident within a few months. BT must always be considered in the context of hyperparathyroidism and osteolytic lesions. Vertebral BT can be particularly devastating due to medullar compression symptoms. Regression or complete disappearance of these lesions after parathyroidectomy is common, but prompt surgical decompression is necessary in case of medullar compression symptoms.

Brown Tumor of Hyperparathyroidism Masquerading as Central Giant Cell Granuloma in a Renal Transplant Recipient: A Case Report

The brown tumor of hyperparathyroidism is histologically identical to the central giant cell granuloma (CGCG), but these lesions can be differentiated based on history and laboratory findings. Herein we have reported a 46-year-old renal transplant recipient in whom brown tumors of hyperparathyroidism were detected several years following renal transplantation. The lesions initially masqueraded as a CGCG with an intranasal mass and ethmoid bone involvement at 7-years posttransplantation, for which surgical resection had been performed. Six years later, she developed multiple expansile bony lesions of the chest wall with histologic features of multinucleated giant cells. A markedly elevated parathyroid hormone level led us to make a diagnosis of brown tumor of hyperparathyroidism. Hence, we propose that clinicians consider brown tumor of hyperparathyroidism to be a potential cause of giant cell lesions among renal transplant recipients. Moreover, careful follow-up examinations are required for such patients to make a timely and accurate diagnosis.

Multiple brown tumors of the orbital walls: case report

We report the case of a 40-year-old woman with chronic renal failure and secondary hyperparathyroidism that presented with slowly progressive proptosis of the right eye and mass sensation in the temporal and frontal orbital margins. Computerized tomography scan revealed two separate hyperdense and well-circumscribed lesions in the right orbital walls. A biopsy followed by histopathologic study revealed a dense lesion, with fibrous proliferation associated with osseous metaplasia and osteoclastic activity in the tumor, compatible with the diagnosis of brown tumor. The patient was submitted to surgical removal of the parathyroid glands that resulted in marked improvement in her condition and regression of the orbital tumors. Although the occurrence of more than one separate bone lesion in the orbit usually suggests metastasis, our case shows that brown tumors should also be included in the differential diagnosis of such lesions, particularly in patients with hyperparathyroidism.

Brown Tumor of Secondary Hyperparathyroidism Involving the Superior Orbit and Frontal Calvarium

A 29-year-old white man with chronic renal failure on hemodialysis presented with a subacute onset of painful proptosis, inferior displacement and limited upgaze of his right globe, and a tender, palpable fronto-temporal mass beneath the right scalp. A cranio-orbitotomy was performed to completely excise a large, necrotic, multilocular, cystic, heterogeneous mass. Histopathologic examination with light microscopy demonstrated the characteristic findings of a giant cell tumor. Based on the patient's history of renal failure and laboratory evidence of hyperparathyroidism, a diagnosis of brown tumor was determined.