A brown tumour (aka osteitis fibrosa cystica) is one of the manifestations of hyperparathyroidism. It represents a reparative cellular process, rather than a neoplastic process.
Brown tumours have a slightly greater frequency in primary than in secondary hyperparathyroidism (3 versus 2%). However, secondary hyperparathyroidism is much more common than primary hyperparathyroidism, therefore most of brown tumours that are seen are associated with secondary hyperparathyroidism.
In chronic renal disease, continual, excessive urinary calcium excretion can lower serum calcium level and lead to a rise in parathormone secretion where skeletal calcium is mobilized to maintain normal serum calcium levels.
This mobilization occurs through rapid osteoclastic turnover of bone, a direct effect of parathormone.
In localized regions where bone loss is particularly rapid, haemorrhage, reparative granulation tissue, and active, vascular, proliferating fibrous tissue may replace the normal marrow contents, resulting in a brown tumor.
Haemosiderin imparts the brown colour (hence the name of the lesions).
Well-defined, purely lytic lesions that provoke little reactive bone. The cortex may be thinned and expanded, but will not be penetrated.
Attenuation values on CT will be in the range of blood and fibrous tissue.
The MRI appearance depends on the relative proportion of its components. The lesions therefore may be solid, cystic, or mixed. Solid components are intermediate to low intensity on T1- and T2-weighted images, while the cystic components are hyperintense on T2-weighted images and may have fluid-fluid levels.
- T1 C+ (Gd) - there can be enhancement of the solid component and septae.
Lesions are usually hypervascular
Often shows intense uptake
- mnemonic for the differential diagnosis of a benign, lytic bone lesion : FEGNOMASHIC
- 1. Chew FS, Huang-hellinger F. Brown tumor. AJR Am J Roentgenol. 1993;160 (4): 752. AJR Am J Roentgenol (citation) - Pubmed citation
- 2. Kattan KR, Campana HA. Case report 232. Brown tumor of the right seventh rib with osteomalacia and secondary hyperparathyroidism. Skeletal Radiol. 1983;10 (1): 47-52. - Pubmed citation
- 3. Hong WS, Sung MS, Chun KA et-al. Emphasis on the MR imaging findings of brown tumor: a report of five cases. Skeletal Radiol. 2011;40 (2): 205-13. doi:10.1007/s00256-010-0979-0 - Pubmed citation
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