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Case Reports
. 2024 Jul 2;16(7):e63645.
doi: 10.7759/cureus.63645. eCollection 2024 Jul.

Brown Tumor of the Dorsal Spine With Hemorrhage Causing Acute Neurological Deterioration: A Rare Presentation of Secondary Hyperparathyroidism

Siddharth Srinivasan  1 , Bharat Raju  1 , Rajesh Nair  1 , Ajay Hegde  2 , Sarah Johnson  3 , Girish Menon  4
Affiliations
Case Reports

Brown Tumor of the Dorsal Spine With Hemorrhage Causing Acute Neurological Deterioration: A Rare Presentation of Secondary Hyperparathyroidism

Siddharth Srinivasan et al. Cureus. .

Abstract

Brown tumor due to secondary hyperparathyroidism in chronic kidney disease is a well-established entity. Brown tumor of the spine with hemorrhage causing acute neurological deficit is a rare entity. A 35-year-old gentleman, with chronic kidney disease (CKD) on dialysis, presented with acute paraplegia and loss of lower limb sensation and bowel and bladder control. Imaging revealed a T8 vertebral body expansile lytic lesion with collapse, exaggerated kyphosis, and cord compression. He underwent an emergency decompressive laminectomy and transpedicular corpectomy of T8, with posterior stabilization. Histopathology revealed lobular clusters of osteoclast-like multinucleated giant cells with background of which was possibly the reason for acute neurological deterioration in this case. Brown tumors of the spine can mimic lytic lesions of the spine like myeloma and metastasis. Suspicion must be raised given in the setting of CKD and hyperparathyroidism. They can present with hemorrhage and acute neurological deficit, which warrants urgent surgical intervention for optimal outcomes.

Keywords: brown tumor; chronic kidney disease; hemorrhage; secondary hyperparathyroidism; spine.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Computed tomography (CT) of the spine sagittal, T8 vertebral body expansile lytic lesion with collapse and impending kyphosis, as indicated by the arrow
Figure 2
Figure 2. Computed tomography (CT) of the spine axial view, T8 lytic lesion involving the vertebral body, extending into the pedicle (arrow) and lamina
Figure 3
Figure 3. T1- Post-gadolinium contrast - magnetic resonance imaging (MRI), mid-sagittal view of the spine demonstrating a heterogenous contrast-enhancing lesion involving the body with collapse (vertical arrow) with significant spinal cord compression (horizontal arrow)
Figure 4
Figure 4. T6, T7, T9, T10 pedicle screw stabilization, cage visible in the depth; adequately decompressed spinal cord noted
Figure 5
Figure 5. Postoperative CT and X-ray of the spine depicted adequate kyphosis correction and appropriate screw-rod construct positioning
Figure 6
Figure 6. Histopathology revealed clusters of osteoclast-like multinucleated giant cells, hemosiderin-laden macrophages, and hemorrhages
See this image and copyright information in PMC

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