Brown Tumor of the Tibia as an Initial Manifestation of Primary Hyperparathyroidism: Case Report

以脛骨棕色瘤來表現的原發性副甲狀腺亢進：病例報告

張信雄(Hsin-Hsiung Chang) ； 張家築(Chia-Chu Chang) ； 劉淨蘭(Jing-Lan Liu) ； 葉坤土(Kun-Tu Yeh) ； 楊力衡(Li-Heng Yang) ； 邱炳芳(Ping-Fang Chious)

《Acta Nephrologica》 24卷3期 (2010/07) Pp. 167-169

摘要

Background: Brown tumors (osteoclastomas) are tumors of the bone that may result from primary or secondary hyperparathyroidism. These tumors are rare in modern times because early diagnosis of primary hyperparathyroidism is relatively easy.
Case report: We present the case of a 57-year-old man with a history of hypertension who visited our outpatient department due to pain in his left lower leg for the previous three months. An X-ray of his left tibia indicated an eccentric osteolytic lesion in the diaphysis and magnetic resonance imaging confirmed a neoplasm. Laboratory data indicated elevated serum Ca (15.2 mg/dL) and iPTH (＞2500 pg/mL). A Tc-methoxyisobutylisonitrile parathyroid scan suggested adenoma lesions involving the right lower thyroid beds. Right lower lobe parathyroidectomy and curettage of the left tibial lesion were performed. Pathology of the tibial tumor confirmed brown tumor. After surgery, the patient's iPTH (13.9 pg/mL) and Ca (8.4 mg/dL) returned to normal. Conclusion: Brown tumor due to primary hyperparathyroidism is rare. We suggest measurement of serum iPTH and calcium when a bone tumor is suspected of being a brown tumor.

關鍵字

棕色瘤 ； 原發性副甲狀腺亢進

並列摘要

Background: Brown tumors (osteoclastomas) are tumors of the bone that may result from primary or secondary hyperparathyroidism. These tumors are rare in modern times because early diagnosis of primary hyperparathyroidism is relatively easy.
Case report: We present the case of a 57-year-old man with a history of hypertension who visited our outpatient department due to pain in his left lower leg for the previous three months. An X-ray of his left tibia indicated an eccentric osteolytic lesion in the diaphysis and magnetic resonance imaging confirmed a neoplasm. Laboratory data indicated elevated serum Ca (15.2 mg/dL) and iPTH (＞2500 pg/mL). A Tc-methoxyisobutylisonitrile parathyroid scan suggested adenoma lesions involving the right lower thyroid beds. Right lower lobe parathyroidectomy and curettage of the left tibial lesion were performed. Pathology of the tibial tumor confirmed brown tumor. After surgery, the patient's iPTH (13.9 pg/mL) and Ca (8.4 mg/dL) returned to normal. Conclusion: Brown tumor due to primary hyperparathyroidism is rare. We suggest measurement of serum iPTH and calcium when a bone tumor is suspected of being a brown tumor.

並列關鍵字

Brown tumor ； tibia ； primary hyperparathyroidism