A Patient With Femoral Osteitis Fibrosa Cystica Due To Hyperparathyroidism: A Case Report

Background: Osteitis fibrosa cystica is a rare benign, lytic bone lesion attributed to hyperparathyroidism. The high level of parathyroid hormone cause rapid bone loss.Case presentation: The patient is a 50-year-old male complaining of severe sustained pain of the right knee joint. Imaging studies were suspicious for a benign tumor of the right distal femur. Biopsy under CT guidance showed numerous osteoclast aggregation and hemosiderin deposition around the bone trabeculae. Blood tests disclosed significantly elevated parathyroid hormone, serum calcium, serum alkaline phosphatase. Parathyroid ultrasonography and CT scan showed a solid mass in front of the trachea at the thoracic entrance plane. After resection of the mass, the clinical symptoms were relieved and the radiological findings were significantly improved, which further confirmed the diagnosis.Conclusions: Metabolic diseases-associated bone lesions require a comprehensive diagnosis of multiple inspection items.An interprofessional team approach to the diagnosis and treatment of Osteitis fibrosa cystica will provide the best outcome.

Brown Tumors of the Mandible Revealing Hyperparathyroidism: About Two Cases

The diagnosis of osteolytic lesions of the jaws can be challenging. Case Reports: Two cases of brown tumor of hyperparathyroidism were reported. A 76- year-old female patient presented with indolent swelling of her right lower jaw measuring approximately 5 cm /6 cm. The panoramic radiograph showed a well-defined osteolytic radiolucency involving the entire mandibular symphysis. Blood investigations revealed High level of parathyroid Hormone (PTH): 102pg/ml. The diagnosis of a brown tumor of hyperparathyroidism was suspected. A parathyroid technetium scintiscan revealed abnormally high uptake at the lower pole of the thyroid lobe interpreted as hyperplasia of right inferior parathyroid gland with possible brown tumor of the mandible. Second case: A 36- year-old female patient presented for the replacement of her missing teeth. Her medical history revealed chronic renal failure and a recent surgical excision of an Osteitis fibrosa cystica of her fifth left proximal phalange. Panoramic radiograph showed multiple well defined osteolytic lesions of the mandible. The diagnosis of a brown tumor of the mandible secondary to hyperparathyroidism was suspected. Laboratory investigations showed increased PTH level, serum hypocalcemia and hyperphosphatemia and vitamin D deficiency. The patient was referred to the department of endocrinology for further investigation and the correction of PTH level. At Six months follow up all the lesions disappeared on radiological control. Discussion: Brown tumor of hyperparathyroidism is a metabolic disorder causing bone resorption that can affect the jaw bones. Clinical symptoms depend on the size and the location of the lesion. Radiographically, it appears as radiolucent unique or multiple well-defined intra-osseous radiolucency. Biological examination is the key to the diagnosis and it is marked by high level of parathyroid hormone (PTH). Key words: Jaw, Tumors, Osteitis Fibrosa Cystica, Hyperparathyroidism, Diagnosis.

Tumores pardos en hiperparatiroidismo

Las glándulas paratiroideas son pequeñas glándulas ubicadas en la región posterior de los lóbulos tiroideos, encargadas del metabolismo mineral del cuerpo, especialmente del calcio y el fósforo. Al verse afectadas estas glándulas van a ocasionar alteraciones hormonales conocidas como hipoparatiroidismo o hiperparatiroidismo. El hiperparatiroidismo es un aumento de la hormona paratiroidea, que lo vamos a dividir como primario, secundario o terciario. La osteítis fibrosa quística es una patología ósea a causa de un hiperparatiroidismo sostenido, normalmente primario. Esta enfermedad se presenta debido a una remodelación de los huesos que normalmente se va a ver reflejado como tumores pardos de células gigantes. Estos tumores son lesiones donde la actividad osteoclástica es mayor a la osteogénica, dejando espacios sin tejido óseo. La hemorragia, el tejido de granulación y el tejido fibroso, proliferan y generan una expansión considerable de hueso que se manifiesta como masa o como fractura. Los tumores pardos son lesiones benignas que normalmente se van a presentar en huesos largos y pueden presentar apariencia de malignidad, teniendo estos un manejo totalmente diferente. La diferenciación se debe hacer tanto histopatológicamente como radiológicamente, aunque siempre lo debemos sospechar al tener niveles séricos aumentados de calcio y niveles altos o inapropiadamente normales de PTH, con bajos niveles de fosfato. Estas lesiones son difíciles de diagnosticar ygeneralmente desaparecen al realizar una paratiroidectomía, aunque puede que sea necesario una osteoplastia para lesiones de gran tamaño,

Molecular Imaging with 18F-FDG PET/CT and 99mTc-MIBI SPECT/CT in Osteitis Fibrosa Cystica Generalisata

Benign so-called “brown tumors” secondary to hyperparathyroidism are a rare diagnostic pitfall due to their impressively malignant-like character in various imaging modalities. We present the case of a 65-year-old male patient with multiple unclear osteolytic lesions on prior imaging suspicious for metastatic malignant disease. Eventually, findings of 18F-FDG PET/CT staging and 99mTc-MIBI scintigraphy resulted in revision of the initially suspected malignant diagnosis. This case illustrates how molecular imaging findings non-invasively corroborate the correct diagnosis of osteitis fibrosa cystica generalisata with the formation of multiple benign brown tumors.

Tumor pardo tibial como forma de presentación de un hiperparatiroidismo primario

La osteítis fibrosa quística es la complicación de un hiperparatiroidismo muy evolucionado. Debido a que la determinación del calcio, hormona paratiroides y vitamina D han pasado a ser estudios rutinarios, esta complicación ósea es infrecuente en los países occidentales. Sin embargo, debe ser considerada en el diagnóstico diferencial de hipercalcemia y lesiones óseas líticas. El tratamiento de esta entidad va dirigido a suprimir el exceso de hormona paratiroides mediante la paratiroidectomia y osteosíntesis en los casos de fracturas patológicas. Se presenta el caso de una paciente con hiperparatiroidismo primario y un tumor pardo en la tibia derecha.

Osteitis fibrosa cystica mimicking bone tumor, a case report

Background We report a case of osteitis fibrosa cystica, a rare benign resorptive bone lesion caused by hyperparathyroidism, that presented on imaging as an aggressive bone tumor. Case presentation The patient is a 51-year-old male complaining of severe sustained pain of the right hip region. Imaging studies were suspicious for a malignant tumor of the right iliac bone. Biopsy under CT guidance was performed and showed remodeled bone trabeculae with numerous osteoclasts, excluding bone tumor and raising the possibility of osteitis fibrosa cystica. Complementary tests disclosed elevated blood level of parathyroid hormone and a partially cystic enlarged left inferior parathyroid gland consistent with adenoma. After parathyroidectomy, the clinical symptoms were relieved and the radiological findings were significantly improved, which confirmed the diagnosis. Conclusions Metabolic diseases-associated bone lesions should always be considered in the differential diagnosis of bone tumors, to avoid unnecessary surgeries and treatments.

Osteitis Fibrosa Cystica A Rare Presentation of Primary Hyperparathyroidism

Introduction: Osteitis fibrosa cystica (OFC) is the most serious bone involvement of primary hyperparathyroidism (PHPT), it is characterized by subperiosteal resorption, lytic lesions and the appearance of brown tumors; this is why, in some cases, this condition can easily be mistaken for a malignant neoplasm. Its prevalence in developed countries is only 5%. Clinical Case: We present a 58-year-old woman, with no relevant personal history, who came to the emergency room with pain in her right shoulder after an accidental fall on the bus. The humerus radiograph shows a pathological fracture of the right humerus, with significant osteopenia. In the emergency analysis, serum Calcium 13.3 mg / d), Ionic Calcium 7.03 mg / dL, Phosphorus 2.4 mg / dL, Alkaline Phosphatase 248 U / L and normal kidney function stand out. With a diagnosis of severe hypercalcemia, treatment was started in the emergency room with serum therapy (1000 ml of 0.9% physiological saline in 4 hours) and intravenous diuretic treatment (furosemide 40mg) with a decrease in calcemia to 12.8mg / dL. Later, she was admitted to the Internal Medicine hospital ward to perform a differential diagnosis of hypercalcemia secondary to a primary tumor, Multiple Myeloma or Primary Hyperparathyroidism. The study findings are: Calcium metabolism: PTH 660 pg / ml (12 - 65), 25 Hydroxyvitamin D: 14.00. Thyroid ultrasound: Posterocaudal to right thyroid lobe, an area of ​​echogenicity slightly lower than the thyroid is identified, of dimensions not estimated by endothoracic component, which could correspond to a parathyroid adenoma. Body CT: Neck: Heterogeneous nodule dependent on the posterior region of the right thyroid nodule with endothoracic extension. Skeleton: Lytic lesions with a tumor aspect in the humerus, right scapula and bilateral seventh rib and right pubic branch. Skull: Diffuse increase in bone density of the calvaria, showing multiple punctate lytic lesions with a permeative appearance. Bone densitometry: Femur neck: - <1.5, Lumbar spine: - <3.0 With the diagnosis of PHPT causing osteitis fibrosa cystica, surgical intervention was decided. Under general anesthesia, a selective right approach was performed, finding a large parathyroid adenoma weighing 17 grams. PTH fell to 36 pg / ml after surgery. At 9 months after surgery, the patient presented calcium levels of 9 mg / dl and PTH 146 pg / ml with clear radiological improvement. Discussion: Osteitis fibrosa cystica is rare in our environment, it is often confused with other neoplasms. After parathyroidectomy, patients with PHPT have a marked and sustained recovery from OFC, although in some cases this recovery can only be achieved after several years. We consider this case of interest, since it illustrates the importance of evaluating the study of phospho-calcium metabolism and parathyroid function in all patients with bone lesions to rule out Primary Hyperparathyroidism with OFC.