Clin Exp Otorhinolaryngol.  2013 Jun;6(2):110-113.

Osteitis Fibrosa Cystica Mistaken for Malignant Disease

• Lee JH
• Chung SM
• Kim HS

Abstract

A 65-year-old man with back pain had plain radiographs that showed multiple osteolytic bone lesions of the pelvis, femur and L-spine; an magnetic resonance imaging scan of the L-spine showed extensive bony resorption with a posterior epidural mass involving the L1 spinous process; these findings suggested multiple myeloma or bony metastasis. However, all serology testing was negative. The parathyroid hormone and serum calcium levels were found to be abnormally elevated. A fine needle aspiration biopsy suggested that the L-spine lesion was consistent with the diagnosis of osteitis fibrosa cystica. A pathological fracture of the spine compressed the spinal cord, and surgical intervention was required. The neck computed tomography and Tc-99m sestamibi scan showed a solitary parathyroid mass. A minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring was performed and two enlarged parathyroid glands identified. This case illustrates the importance of the consideration of a rare brown tumor associated with primary hyperparathyroidism in patients with the bone lesions suggestive of a malignancy.

Keyword

Hyperparathyroidism; Osteitis fibrosa cystica; Brown tumor

MeSH Terms

Back Pain
Biopsy
Biopsy, Fine-Needle
Calcium
Femur
Fractures, Spontaneous
Humans
Hyperparathyroidism
Hyperparathyroidism, Primary
Magnetic Resonance Imaging
Multiple Myeloma
Neck
Neoplasm Metastasis
Osteitis
Osteitis Fibrosa Cystica
Parathyroid Glands
Parathyroid Hormone
Parathyroidectomy
Pelvis
Spinal Cord
Spine
Calcium
Parathyroid Hormone

Figure

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  Fig. 1 Plain radiographs of lumbar spine (A), pelvis and femur (B) showing subperiosteal erosion and generalized osteopenia.

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  Fig. 2 T2 weighted sagittal magnetic resonance imaging scan of the lumbar spine showing a compression fracture in L2 and an enhancing expansile mass (arrow) in the L1 spinous process.

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  Fig. 3 Fludeoxyglucose-positron emission tomography (FDG-PET) image showing multiple intense FDG uptake in the bones: spine, ribs, both iliac bones and acetabulums, and diffuse bone marrow activation.

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  Fig. 4 (A) Neck computed tomography, axial scan showing mass lesion (arrow head) in the posterior part of the right thyroid gland suggestive of a parathyroid tumor. (B) A sestamibi scan was performed and nodular uptake of radiotracer in the inferior pole of the right thyroid area (arrow) was observed on the early and delayed images; the delayed image shows washout of the normal thyroid tissue activity and focal uptake is seen as discrete.

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  Fig. 5 This section shows diffuse proliferation of osteoclast-type giant cells intermixed osteoblastic proliferation, and neovascularizaion, suggestive of the characteristic findings of osteitis fibrosa cystica (H&E, ×200).

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