Hip Pelvis.  2018 Jun;30(2):120-124. 10.5371/hp.2018.30.2.120.

Subchondral Bone Restoration of Supra-acetabular Brown Tumor Secondary to Parathyroid Carcinoma: A Case Report

Affiliations
  • 1Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea. chiasma@hanmail.net

Abstract

The causes of osteolytic lesions found in radiological examinations are not quite certain. Therefore, to determine the appropriate treatment method, various approaches and analyzes are required to find the real cause. Hyperparathyroidism is one of the diseases which forms osteolytic bone lesions so-called brown tumor. A 55-year-old woman who had painful osteolytic bone lesions in both hip joint areas was diagnosed as parathyroid carcinoma after serial work-up. She underwent parathyroidectomy and follow-up imaging showed a decrease in brown tumor size and bone consolidation in the subchondral bone destruction area. Proper evaluation of osteolytic bone lesions helps to avoid unnecessary operative treatments and the first choice for the treatment of osteolytic bone lesions caused by parathyroid carcinoma is parathyroidectomy.

Keyword

Hip joint; Osteitis fibrosa cystica; Hyperparathyroidism; Parathyroidectomy; Calcium phosphate

MeSH Terms

Female
Follow-Up Studies
Hip Joint
Humans
Hyperparathyroidism
Methods
Middle Aged
Osteitis Fibrosa Cystica
Parathyroid Neoplasms*
Parathyroidectomy

Figure

  • Fig. 1 Plain radiographs of the hip. (A) Large tumor lesion in the right acetabulum area involving the hip joint and the left femoral neck area. (B) Immediate postoperative image of prophylactic compressive hip screw fixation for a left femoral neck lesion. (C) The tumor gradually diminished in size 1 year after parathyroidectomy, with the appearance of calcification.

  • Fig. 2 Pelvic computed tomography showing (A) a large osteolytic lesion in the right pelvis with a thin cortex, shown in the axial view; and (B) hip joint area involvement, shown in the coronal view. (C) The tumor gradually diminished in size 1 year after parathyroidectomy, together with the appearance of calcification, shown in the axial view; and (D) subchondral bone regeneration involved in the right hip joint area, shown in the coronal view.

  • Fig. 3 Brown tumor lesion of the right acetabulum area, shown in magnetic resonance imaging (A) axial, (B) coronal T1-weighted image, and (C) coronal T2-weighted image.

  • Fig. 4 (A) Fludeoxyglucose F 18 (FDG) positron emission tomography/computed tomography showing a 3.0-cm paratracheal lesion located at the posterior aspect of the right thyroid gland. The lesion demonstrates a low FDG-avid tumor (maximal standardized uptake value [SUVmax], 1.9). (B) Osteolytic and destructive lesions located in the right acetabulum area, suspected of being skeletal metastases with a SUVmax of 7.1.


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