Brown tumor is one of the skeletal manifestation of hyperparathyroidism. Histologically, brown tumor may be difficult to distinguish from other giant cell lesions and a clinical diagnosis is made based on the association with hyperparathyroidism. A 67-year-old woman presented a pathologic fracture of the right ulna, fever and obnubilation. Laboratory tests revealed hypercalcemia (serum calcium level: 15 mg/dl). Malignancy was suspected but staging was negative. Bone scan revealed areas of increased uptake in the right superior limb and in a rib. A TC-guided biopsy was performed with a pathological diagnosis of osteoclastoma. The mass was surgically removed and the final pathological diagnosis was giant-cell lesion. After surgery, laboratory tests revealed hypercalcemia and elevated intact PTH (1 118.47 pg/ml). 99mTc-sestaMIBI scan revealed a right inferior parathyroid iperactivity. Surgical right inferior parathyroidectomy was performed and the lesion was histopathologically diagnosed as an adenoma. After surgery, serum calcium became normal and i-PTH dropped to 363.97 pg/ml. After 1 year, serum calcium was normal but i-PTH was 204 pg/ml and 99mTc-sestaMIBI revealed a left paratracheal iperactivity. Plain radiographs showed multiple osteolytic lesions and abdominal sonography showed a nephrolitiasis. After 3 years, plain radiographs showed marked regression of the bony lesions. It is necessary to exclude the presence of hyperparathyroidism with ionised calcium and i-PTH before performing a histological diagnosis of giant-cell bone tumor.
TUMORE BRUNO DELL’ULNA COME PRIMA MANIFESTAZIONE DI IPERPARATIROIDISMO PRIMITIVO
CALO', PIETRO GIORGIO;NICOLOSI, ANGELO
2005-01-01
Abstract
Brown tumor is one of the skeletal manifestation of hyperparathyroidism. Histologically, brown tumor may be difficult to distinguish from other giant cell lesions and a clinical diagnosis is made based on the association with hyperparathyroidism. A 67-year-old woman presented a pathologic fracture of the right ulna, fever and obnubilation. Laboratory tests revealed hypercalcemia (serum calcium level: 15 mg/dl). Malignancy was suspected but staging was negative. Bone scan revealed areas of increased uptake in the right superior limb and in a rib. A TC-guided biopsy was performed with a pathological diagnosis of osteoclastoma. The mass was surgically removed and the final pathological diagnosis was giant-cell lesion. After surgery, laboratory tests revealed hypercalcemia and elevated intact PTH (1 118.47 pg/ml). 99mTc-sestaMIBI scan revealed a right inferior parathyroid iperactivity. Surgical right inferior parathyroidectomy was performed and the lesion was histopathologically diagnosed as an adenoma. After surgery, serum calcium became normal and i-PTH dropped to 363.97 pg/ml. After 1 year, serum calcium was normal but i-PTH was 204 pg/ml and 99mTc-sestaMIBI revealed a left paratracheal iperactivity. Plain radiographs showed multiple osteolytic lesions and abdominal sonography showed a nephrolitiasis. After 3 years, plain radiographs showed marked regression of the bony lesions. It is necessary to exclude the presence of hyperparathyroidism with ionised calcium and i-PTH before performing a histological diagnosis of giant-cell bone tumor.
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