Korean J Endocr Surg.  2013 Jun;13(2):92-95. 10.0000/kjes.2013.13.2.92.

Brown Tumor of the Humerus Associated with Secondary Hyperparathyroidism: A Case Report of Successful Treatment after Subtotal Parathyroidectomy

Affiliations
  • 1Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea. hspark1@dau.ac.kr

Abstract

Brown tumor is a bone disease that arises in the setting of increased osteoclastic activity and fibroblastic proliferation in the involved bone. It is well recognized as serious complication of hyperparathyroidism. Brown tumor is uncommon, and brown tumor with secondary hyperparathyroidism resulting from chronic renal failure has rarely been reported. We recently experienced a case of a 28-year-old Korean woman with chronic renal failure caused by chronic glomerulonephritis, on hemodialysis for nine years. She has been hospitalized with left shoulder pain for two years. Image studies showed multiple cystic masses, and both suspicious marked thinning and partial destruction of the cortex on the head of the left humerus. Histopathologic analysis of the mass lesion showed a fibrotic capsule, hemosiderin pigmentation, and giant cell, all characteristic of brown tumor. A subtotal parathyroidectomy was done without surgery of the bony lesion (brown tumor), with successful results. We report this case with a brief review of the literature.

Keyword

Brown tumor; Secondary hyperparathyroidism; Parathyroidectomy

MeSH Terms

Adult
Bone Diseases
Female
Fibroblasts
Giant Cells
Glomerulonephritis
Head
Hemosiderin
Humans
Humerus*
Hyperparathyroidism
Hyperparathyroidism, Secondary*
Kidney Failure, Chronic
Osteoclasts
Parathyroidectomy*
Pigmentation
Renal Dialysis
Shoulder Pain
Hemosiderin

Figure

  • Fig. 1. Radiologic findings. Simple X-ray: Geographic expansile intramedullary osteolytic lesion from left proximal humerus head portion to metadiaphysis (A). Upper extremity CT axial view: Multiseptated cystic bone tumor in left humerus metadiaphysis area. Suspicious marked thinning and partial destruction in cortex. Edematous change in muscles and soft tissue area (B). MRI shoulder axial view: Multiseptated cystic bone tumor in left humerus metadiaphysis, prominent thinning in cortex, suspicious cortical destruction, edematous change in muscles and soft tissue area (C). Simple X-ray (5 months after surgery): Reduced expansile and osteolytic lesion of the left proximal humerus head portion (D). Upper extremity CT (5 months after surgery): Markedly reduced cystic portion of left humerus (E).

  • Fig. 2. Pathologic findings. Benign spindle cells and giant cell proliferation lesion with cystic change and hemorrhage (A, ×200), (B, ×400: black arrow heads).

  • Fig. 3. Neck CT: Low density nodular lesion in posterior portion left thyroid gland (arrow).


Reference

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