Multilevel brown tumors of the spine in a patient with severe secondary hyperparathyroidism. A case reportand review of the literature


COD: 2474_31_03_2016_ep Categorie: , ,

̧Daniela Sala, Simona Muresan, Mircea Mures ̧an, Radu Neagoe

Published online (EP) 31 March 2016

La mia nuova descrizione qui!

Price of a print issue €25.00
BACKGROUND. The brown tumour is an extreme form of osteitis fibrosa cystica, representing a serious complication ofthe advanced primary or secondary hyperparathyroidism. It occurs in settings of high levels parathyroid hormone, like inprimary or secondary hyperparathyroidism, with a frequency of 3-4% and 1.5-13% respectively, usually affecting youngpeople.
CASE REPORT. The authors report a case of a 45 years old woman on long-term hemodialysis, with severe secondaryhyperparathyroidism. The main clinical complaints were neck pain, lower thoraco-lumbar back pain, persistent left groinpain, and bilateral lower extremities weakness. The computed tomography scan revealed multiple spine brown tumorsaffecting the cervical, thoracic and lumbar level. After an initial partial response to the treatment of two years withCinacalcet, a deterioration of the secondary hyperparathyroidism occurred (hypercalcemia, hyperphosphatemia) and thepatient was referred for parathyroidectomy. The patient underwent total parathyroidectomy with auto-transplantation,with a positive postoperative result.
CONCLUSIONS. Secondary hyperparathyroidism can lead, during its course, to osteolytic bone lesions called brown tumors.If the medical treatment fails, the surgical removal of the parathyroid glands with autotransplant remains the only treat-ment of the bone lesions progression. Reviewing the relevant literature in English (until March 2015), we found 24 cas-es of symptomatic vertebral brown tumors. To the authors’ knowledge, this is the first case which describes a multilevelspine involvement (more than two), and the fifth describing a cervical localization.