Brown tumor

Case contributed by Dr Dalia Ibrahim

Presentation

Severe back pain.

Patient Data

Age: 30 years
Gender: Female

L3 vertebra show abnormal low signal at T1 & T2 WI involving its left posterolateral aspect and the adjoining left pedicle; it shows avid contrast uptake in the post gadolinium series, related vertebral fracture of its upper endplate and corresponding diminished posterior vertical height. 

Multiple scattered lytic lesions are seen within L1 & L3 vertebrae, both iliac bones, the right lateral mass of the sacrum.

Fracture & sagging of the upper endplate of L3 vertebra.

No extra-osseous soft tissue components.

A big focal area of active tracer uptake is noted below the lower pole of the right thyroid lobe in the early image with partial washout in the late image.

Suggestive of right parathyroid adenoma.

Multiple scattered lytic lesions are seen within L1 & L3 vertebrae, both iliac bones, the right lateral mass of the sacrum.

Case Discussion

Brown tumor, also known as osteitis fibrosa cystica and rarely as osteoclastoma, is one of the manifestations of hyperparathyroidism. It represents a reparative cellular process, rather than a neoplastic process. Histologically brown tumors are identical to giant cell tumor (both are osteoclastomas), and therefore, this entity can easily be misdiagnosed as such if elevated blood calcium and/or parathyroid hormone levels are not assessed for and identified. 

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