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Osteitis fibrosa cystica mistaken for malignant disease.

Lee JH, Chung SM, Kim HS - Clin Exp Otorhinolaryngol (2011)

Bottom Line: The parathyroid hormone and serum calcium levels were found to be abnormally elevated.A minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring was performed and two enlarged parathyroid glands identified.This case illustrates the importance of the consideration of a rare brown tumor associated with primary hyperparathyroidism in patients with the bone lesions suggestive of a malignancy.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

ABSTRACT
A 65-year-old man with back pain had plain radiographs that showed multiple osteolytic bone lesions of the pelvis, femur and L-spine; an magnetic resonance imaging scan of the L-spine showed extensive bony resorption with a posterior epidural mass involving the L1 spinous process; these findings suggested multiple myeloma or bony metastasis. However, all serology testing was negative. The parathyroid hormone and serum calcium levels were found to be abnormally elevated. A fine needle aspiration biopsy suggested that the L-spine lesion was consistent with the diagnosis of osteitis fibrosa cystica. A pathological fracture of the spine compressed the spinal cord, and surgical intervention was required. The neck computed tomography and Tc-99m sestamibi scan showed a solitary parathyroid mass. A minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring was performed and two enlarged parathyroid glands identified. This case illustrates the importance of the consideration of a rare brown tumor associated with primary hyperparathyroidism in patients with the bone lesions suggestive of a malignancy.

No MeSH data available.


Related in: MedlinePlus

Plain radiographs of lumbar spine (A), pelvis and femur (B) showing subperiosteal erosion and generalized osteopenia.
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Figure 1: Plain radiographs of lumbar spine (A), pelvis and femur (B) showing subperiosteal erosion and generalized osteopenia.

Mentions: A 65-year-old man who had severe back pain for one year was referred from a local orthopedic clinic to the department of oncology in our hospital, because plain radiographs showed multiple osteolytic lesions of the pelvis, femur and vertebrae (Fig. 1). Three years previously, he had a general physical examination showing no specific problems. However, one year ago, he was treated for a left femur fracture. The lumbar spine MRI showed that the vertebral bodies had low signal intensity due to osteoporosis, a compression fracture of the L2 spine and the L1 spinous process with a mass lesion; these findings were suggestive of bone metastasis or multiple myeloma (Fig. 2). The blood chemistry findings showed that the serum beta-2 microglobulin was 7,860 ng/mL (700-1,800) but the serum IgG, IgA, IgM and tumor markers were all negative and the serum protein electrophoresis and urine protein electrophoresis were negative for a monoclonal gammopathy. However, the alkaline phophatase was 6,788 IU/L (40-250), total calcium was 12.8 mg/dL (8.2-10.5), ionized calcium was 6.5 pg/mL (4.3-5.0) and the PTH was 1,889 pg/dL (0-65). The chest X-ray showed diffuse osteoblastic and some osteolytic lesions of the bony thorax. The bone mineral density studies of the spine and femur were consistent with osteoporosis. The computed tomography (CT) of the abdomen and pelvis demonstrated parenchymal calcinosis of the liver and medullary calcinosis of both kidneys. The entire skeleton had diffuse osteoblastic and osteolytic lesions. The fludeoxyglucose-positron emission tomography (FDG-PET) showed multiple areas of FDG uptake in the bones consistent with the pattern of bony metastasis from a malignancy; however, we could not identify a primary lesion (Fig. 3).


Osteitis fibrosa cystica mistaken for malignant disease.

Lee JH, Chung SM, Kim HS - Clin Exp Otorhinolaryngol (2011)

Plain radiographs of lumbar spine (A), pelvis and femur (B) showing subperiosteal erosion and generalized osteopenia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3687060&req=5

Figure 1: Plain radiographs of lumbar spine (A), pelvis and femur (B) showing subperiosteal erosion and generalized osteopenia.
Mentions: A 65-year-old man who had severe back pain for one year was referred from a local orthopedic clinic to the department of oncology in our hospital, because plain radiographs showed multiple osteolytic lesions of the pelvis, femur and vertebrae (Fig. 1). Three years previously, he had a general physical examination showing no specific problems. However, one year ago, he was treated for a left femur fracture. The lumbar spine MRI showed that the vertebral bodies had low signal intensity due to osteoporosis, a compression fracture of the L2 spine and the L1 spinous process with a mass lesion; these findings were suggestive of bone metastasis or multiple myeloma (Fig. 2). The blood chemistry findings showed that the serum beta-2 microglobulin was 7,860 ng/mL (700-1,800) but the serum IgG, IgA, IgM and tumor markers were all negative and the serum protein electrophoresis and urine protein electrophoresis were negative for a monoclonal gammopathy. However, the alkaline phophatase was 6,788 IU/L (40-250), total calcium was 12.8 mg/dL (8.2-10.5), ionized calcium was 6.5 pg/mL (4.3-5.0) and the PTH was 1,889 pg/dL (0-65). The chest X-ray showed diffuse osteoblastic and some osteolytic lesions of the bony thorax. The bone mineral density studies of the spine and femur were consistent with osteoporosis. The computed tomography (CT) of the abdomen and pelvis demonstrated parenchymal calcinosis of the liver and medullary calcinosis of both kidneys. The entire skeleton had diffuse osteoblastic and osteolytic lesions. The fludeoxyglucose-positron emission tomography (FDG-PET) showed multiple areas of FDG uptake in the bones consistent with the pattern of bony metastasis from a malignancy; however, we could not identify a primary lesion (Fig. 3).

Bottom Line: The parathyroid hormone and serum calcium levels were found to be abnormally elevated.A minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring was performed and two enlarged parathyroid glands identified.This case illustrates the importance of the consideration of a rare brown tumor associated with primary hyperparathyroidism in patients with the bone lesions suggestive of a malignancy.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

ABSTRACT
A 65-year-old man with back pain had plain radiographs that showed multiple osteolytic bone lesions of the pelvis, femur and L-spine; an magnetic resonance imaging scan of the L-spine showed extensive bony resorption with a posterior epidural mass involving the L1 spinous process; these findings suggested multiple myeloma or bony metastasis. However, all serology testing was negative. The parathyroid hormone and serum calcium levels were found to be abnormally elevated. A fine needle aspiration biopsy suggested that the L-spine lesion was consistent with the diagnosis of osteitis fibrosa cystica. A pathological fracture of the spine compressed the spinal cord, and surgical intervention was required. The neck computed tomography and Tc-99m sestamibi scan showed a solitary parathyroid mass. A minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring was performed and two enlarged parathyroid glands identified. This case illustrates the importance of the consideration of a rare brown tumor associated with primary hyperparathyroidism in patients with the bone lesions suggestive of a malignancy.

No MeSH data available.


Related in: MedlinePlus