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JCEM Case Rep
JCEM Case Rep
jcemcr
JCEM Case Reports
2755-1520
Oxford University Press US

39193093
10.1210/jcemcr/luae157
luae157
Image in Endocrinology
AcademicSubjects/MED00010
AcademicSubjects/MED00160
AcademicSubjects/MED00250
AcademicSubjects/MED00300
AcademicSubjects/MED00905
Multiple Brown Tumors in Primary Hyperparathyroidism
https://orcid.org/0009-0000-1207-4662
Chhachhar Abrar Ali Section of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Aga Khan University, Karachi 74800, Pakistan

https://orcid.org/0000-0002-0998-4347
Masood Muhammad Qamar Section of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Aga Khan University, Karachi 74800, Pakistan

Correspondence: Muhammad Qamar Masood, MBBS, Section of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Aga Khan University, Stadium Road, Karachi 74800, Pakistan. Email: qamar.masood@aku.edu.
9 2024
27 8 2024
27 8 2024
2 9 luae15722 5 2024
14 8 2024
27 8 2024
© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.
2024
https://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. See the journal About page for additional terms.

brown tumors
hyperparathyroidism
parathyroidectomy
osteitis fibrosa cystica
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pmcImage Legend

A 58-year-old woman with history of renal stones was evaluated after her chest radiograph incidentally revealed left pleural lesions (Fig. 1A). Computed tomography revealed multiple mixed sclerotic and lytic expansile lesions in the left eighth, ninth, and tenth ribs (Fig. 1B and 1C). Similar lesions were seen in the scapula (Fig. 1B), pelvic bones, and vertebra (Fig. 1D and 1E). On laboratory investigations, calcium was 12.6 mg/dL (3.15 mmol/L) (normal range [NR], 8.6-10.2 mg/dL [2.15-2.55 mmol/L]), phosphate was 4.4 mg/dL (1.42 mmol/L) (NR, 2.51-4.50 mg/dL [0.81-1.45 mmol/L]), and parathyroid hormone (PTH) level was 804 ng/L (16-87 ng/L). Ultrasound neck localized a large parathyroid adenoma at the lower left thyroid lobe. The patient underwent parathyroidectomy and histopathology revealed fat-depleted parathyroid tissue with a solid pattern of predominantly chief cells and focal oxyphil cells, confirming parathyroid adenoma. Confirmation of hyperparathyroidism established the diagnosis of brown tumors (BTs). Postoperative PTH was less than 3 ng/L. Despite the successful parathyroidectomy, the patient later died of an unrelated critical illness. BTs, rare variants of osteitis fibrosa cystica, are nonmalignant tumors of the giant cell family caused by high PTH, resulting in cystic fibrous tumors of the bone [1]. Radiologically often misunderstood as malignant lesions, BTs are diagnosed clinically in hyperparathyroidism as they cannot be distinguished from other giant cell lesions due to histological similarities [2]. This case emphasizes recognition of BTs in primary hyperparathyroidism.

Figure 1. A, Pleural lesions involving eighth, ninth, and tenth ribs. B, Mixed sclerotic and lytic lesions with cortical expansion in the scapula and left ninth rib (39 × 15 mm) near angle of the rib. C, Mixed sclerotic and lytic lesion in left tenth rib (30 × 16.4 mm) posteriorly. D and E, Multiple expansile mixed solid and lytic lesions in both iliac bones and L5 vertebral body. F, A lytic lesion of T11 vertebral body.

Funding

No public or commercial funding.

Disclosures

None declared.

Informed Patient Consent for Publication

Signed informed consent obtained directly from the patient's relatives or guardians.

Abbreviations

BT brown tumor

PTH parathyroid hormone
==== Refs
References

1 Shavlokhova  V, Goeppert  B, Gaida  MM, et al  Mandibular brown tumor as a result of secondary hyperparathyroidism: a case report with 5 years follow-up and review of the literature. Int J Environ Res Public Health. 2021;18 (14 ):7370.34299820
2 Zhou  Z, Shi  Y, Li  C, Wang  W. Primary hyperparathyroidism-induced brown tumors caused by parathyroid carcinoma: a case report and literature review. J Int Med Res. 2022;50 (9 ):03000605221123668.
