Case Report

Missed Brown Tumors in a Young Adult with Decreased Bone Density

Authors: Hao-Lun Kao, MD, Wei-Chou Chang, MD, Chian-Her Lee, MD, Herng-Sheng Lee, MD, Guo-Shu Huang, MD

Abstract

Brown tumors, a benign osteolytic process, are most commonly caused by hyperparathyroidism. Multiple bone involvement is relatively rare. There are many similarities in the radiologic and histological features of brown tumors and giant cell tumors (GCTs) of bone. Differentiation between the two lesions is dependent upon evaluation of serum biochemistry including serum calcium, phosphorous, and intact parathyroid hormone (I-PTH) levels. Herein, the case of a 32-year-old man with multiple osteolytic lesions of the left tibia and fibula as well as the fourth metacarpal bone of the left hand, previously misdiagnosed with multiple GCTs, is presented. Based on the radiographic findings and biochemistry results in a young adult patient, brown tumor was suspected and subsequently definitively diagnosed.


Key Points


* Brown tumors can present as multiple expansile, osteolytic lesions with internal septations as well as osteopenia and osteoporosis.


* The image findings and histology of brown tumors may mimic giant cell tumors, and the clinical and biochemical differences are essential in differentiating the two lesions.


* In patients with primary hyperparathyroidism, parathyroidectomy results in the normalization of biochemical values and increased bone mineral density.

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