A Rare Case of Primary Hyperparathyroidism Presenting as a C2 Brown Tumor-Plain Radiography Has yet again Proved Indispensable in Clinching the Diagnosis

Jyoti Panwar; Tameem A. Bhat; Saket Ballabh; Deepak Abraham; Felix K. Jebasingh

doi:10.1055/s-0042-1755266

Indian Journal of Radiology and Imaging, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2022; 32(04): 615-620
DOI: 10.1055/s-0042-1755266

Case Report

A Rare Case of Primary Hyperparathyroidism Presenting as a C2 Brown Tumor-Plain Radiography Has yet again Proved Indispensable in Clinching the Diagnosis

Autor*innen

Jyoti Panwar

¹Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
Tameem A. Bhat

¹Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
Saket Ballabh

¹Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
Deepak Abraham

²Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India
Felix K. Jebasingh

³Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India

Abstract

A brown tumor is one of the manifestations of hyperparathyroidism. It is a rare type of bone lesion that most often occurs in mandible, ribs, and large bones. Spinal involvement is extremely rare. We report an unusual case of a brown tumor of the axis vertebra in a 33-year-old male who presented to the orthopaedic clinic with posttraumatic C2 vertebra fracture and myelopathy. To plan further fixation and stabilization of C2 fracture, the patient underwent a plain radiograph and magnetic resonance imaging (MRI) of the cervical spine. The available routine chest radiograph at the time of MRI reporting clinched the diagnosis of primary hyperparathyroidism with a brown tumor of the axis vertebra. Thus, familiarity with subtle radiographic findings of this condition not only led to early diagnosis and appropriate treatment but also avoided unnecessary C2 biopsy and hardware fixation.

Keywords

primary hyperparathyroidism - brown tumor - plain radiograph - C2 vertebra - axis vertebra

Volltext

Referenzen

References
1 Hoshi M, Takami M, Kajikawa M. et al. A case of multiple skeletal lesions of brown tumors, mimicking carcinoma metastases. Arch Orthop Trauma Surg 2008; 128 (02) 149-154
2 Chew FS, Huang-Hellinger F. Brown tumor. AJR Am J Roentgenol 1993; 160 (04) 752
3 Hayes CW, Conway WF. Hyperparathyroidism. Radiol Clin North Am 1991; 29 (01) 85-96
4 Jackson W, Sethi A, Carp J, Talpos G, Vaidya R. Unusual spinal manifestation in secondary hyperparathyroidism: a case report. Spine 2007; 32 (19) E557-E560
5 Mustonen AO, Kiuru MJ, Stahls A, Bohling T, Kivioja A, Koskinen SK. Radicular lower extremity pain as the first symptom of primary hyperparathyroidism. Skeletal Radiol 2004; 33 (08) 467-472
6 Mateo L, Massuet A, Solà M, Pérez Andrés R, Musulen E, Sánchez Torres MC. Brown tumor of the cervical spine: a case report and review of the literature. Clin Rheumatol 2011; 30 (03) 419-424
7 Alfawareh MD, Halawani MM, Attia WI, Almusrea KN. Brown tumor of the cervical spines: a case report with literature review. Asian Spine J 2015; 9 (01) 110-120
8 Ericsson M, Holm E, Ingemansson S, Lindholm T, Svendgaard NA. Secondary hyperparathyroidism combined with uremia and giant cell containing tumor of the cervical spine. A case report. Scand J Urol Nephrol 1978; 12 (02) 185-187
9 Graziani N, Donnet A, Antipoff M, Gaborit P, Hassoun, Grisoli F. [Recklinhausen brown tumor of the cervical spine disclosing primary hyperparathyroidism]. Neurochirurgie 1991; 37 (06) 394-397
10 Barlow IW, Archer IA. Brown tumor of the cervical spine. Spine 1993; 18 (07) 936-937
11 Ashebu SD, Dahniya MH, Muhtaseb SA, Aduh P. Unusual florid skeletal manifestations of primary hyperparathyroidism. Skeletal Radiol 2002; 31 (12) 720-723
12 Gheith O, Ammar H, Akl A. et al. Spinal compression by brown tumor in two patients with chronic kidney allograft failure on maintenance hemodialysis. Iran J Kidney Dis 2010; 4 (03) 256-259
13 Szeverényi C, Dezsö B, Deményi T, Csernátony Z. Vertebral brown tumor in childhood. Surg Sci 2011; 2: 344-347
14 Resic H, Masnic F, Kukavica N, Spasovski G. Unusual clinical presentation of brown tumor in hemodialysis patients: two case reports. Int Urol Nephrol 2011; 43 (02) 575-580
15 Hsieh MC, Ko JY, Eng HL. Pathologic fracture of the distal femur in osteitis fibrosa cystica simulating metastatic disease. Arch Orthop Trauma Surg 2004; 124 (07) 498-501
16 Joyce JM, Idea RJ, Grossman SJ, Liss RG, Lyons JB. Multiple brown tumors in unsuspected primary hyperparathyroidism mimicking metastatic disease on radiograph and bone scan. Clin Nucl Med 1994; 19 (07) 630-635
17 Xie C, Tsakok M, Taylor N, Partington K. Imaging of brown tumours: a pictorial review. Insights Imaging 2019; 10 (01) 75
18 Lee JH, Chung SM, Kim HS. Osteitis fibrosa cystica mistaken for malignant disease. Clin Exp Otorhinolaryngol 2013; 6 (02) 110-113
19 Hu J, He S, Yang J, Ye C, Yang X, Xiao J. Management of brown tumor of spine with primary hyperparathyroidism: A case report and literature review. Medicine (Baltimore) 2019; 98 (14) e15007
20 Kaya RA, Cavuşoğlu H, Tanik C. et al. Spinal cord compression caused by a brown tumor at the cervicothoracic junction. Spine J 2007; 7 (06) 728-732