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Case Reports
. 2021 Feb 27:63:102197.
doi: 10.1016/j.amsu.2021.102197. eCollection 2021 Mar.

Paraparesis As a Rare First Presentation Of Primary Hyperparathyroidism-Related Brown Tumor in The Thoracic Spine: Case report and literature review

Sultan M Jarrar  1 , Suleiman S Daoud  1 , Omar F Jbarah  1 , Iyad S Albustami  1
Affiliations
Case Reports

Paraparesis As a Rare First Presentation Of Primary Hyperparathyroidism-Related Brown Tumor in The Thoracic Spine: Case report and literature review

Sultan M Jarrar et al. Ann Med Surg (Lond). .

Abstract

Introduction and importance: Brown tumor (BT) is defined as osteolytic lesion of an underlying state of hyperparathyroidism. Hyperparathyroidism will activate osteoclasts which initiate active bone resorption foci of lytic-cysts with hemosiderin depositions that pigment it with its characteristic brown pathologic gross appearance. Devastating fractures and injuries can occur to affected bones and surrounding tissue that require emergent intervention and correction.

Case presentation: We present a case of a medically free 31-year-old female patient, who presented complaining of unsteadiness and progressive lower limbs weakness over 40 days of duration. Subsequent lab tests showed elevated PTH levels, along with 3.5 × 1.8 cm heterogeneous soft tissue mass involving the right pedicle on T7 level compressing the corresponding level of the spinal cord. Surgical management aimed to decompress the spinal cord and to obtain a biopsy for histopathologic examination which revealed a brown tumor. Neck ultrasound and Sestamibi scan indicated the presence of hyperactive and hyperplastic parathyroid tissue most suggestive of parathyroid adenoma.

Clinical discussion: Various presentations of Brown Tumor depend on the bone affected, despite the rarity of spinal involvement, yet expanding tumors can manifest either with back pain, radicular pain, paresthesia, weakness, paralysis, or incontinence. The highest incidence rates of spinal brown tumors affect adults over the age of 40. Management goals are to decompress the neuronal tissue emergently and to prevent further bony lytic deterioration.

Conclusion: The objective of this study is to provide an overview of primary hyperparathyroidism-related spinal brown tumors, presentation, and summary of previously reported similar cases in the literature.

Keywords: Brown tumor; Case report; Primary hyperparathyroidism; Spinal compression; Thoracic spine tumor.

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Conflict of interest statement

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Fig. 1
Fig. 1
(A)(B) sagittal cervicothoracic MRI T2/T1 sequences showing large osteolytic bone lesion 3.5 × 1.8 cm, at level of T7. Significantly distorted the posterior elements of the corresponding vertebral spine. (C) axial MRI cut scan at level of T7 showing expansile osteolytic mass, involving the right pedicle and posterior arch, compressing the spinal canal and dislocating its content to the left.
Fig. 2
Fig. 2
(A) sagittal chest abdomen pelvis CT showing expansile bony mass involving the body, right pedicles and posterior arch of T7. (B) axial T7 CT showing epidural soft tissue component extending from T6-T7 compressing the spinal canal, dislocating its content to the left and scalloping the T7 vertebral body.
Fig. 3
Fig. 3
(A) sagittal MRI demonstrates segmental spinal instrumentation with T5-T9 transpedicular screws fusion. (B) lateral plain XRAY demonstrate T5-T9 transpedicular screws fusion. (C) intra-operative view of T5-T9 transpedicular screws fusion.
See this image and copyright information in PMC

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