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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Brown tumor mimicking bone metastases in a patient with chronic renal failure: A case report

Meeting Abstract

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  • Ceren Kizmazoglu - Department of Neurosurgery, Izmir Katip Çelebi University Atatürk, Training and Research Hospital, Izmir, Turkey
  • Ismail Ertan Sevin - Department of Neurosurgery, Izmir Katip Çelebi University Atatürk, Training and Research Hospital, Izmir, Turkey
  • Ercan Akalin - Department of Neurosurgery, Izmir Katip Çelebi University Atatürk, Training and Research Hospital, Izmir, Turkey
  • Inan Uzunoglu - Department of Neurosurgery, Izmir Katip Çelebi University Atatürk, Training and Research Hospital, Izmir, Turkey
  • Türkan Atasever Rezanko - Department of Pathology, Izmir Katip Çelebi University Atatürk, Training and Research Hospital, Izmir, Turkey
  • Nurullah Yüceer - Department of Neurosurgery, Izmir Katip Çelebi University Atatürk, Training and Research Hospital, Izmir, Turkey

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 040

doi: 10.3205/14dgnc435, urn:nbn:de:0183-14dgnc4351

Published: May 13, 2014

© 2014 Kizmazoglu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Brown tumor is as a result of untreated primary or secondary hyperparathyroidism. A “brown tumor” is known as osteitis fibrosa cystica or von Recklinghausen disease, is not a true neoplasm. Patients with chronic renal failure (CRF) on long-term haemodialysis are at risk of secondary hyperparathyroidism due to phosphate retention and lowered calcitriol levels. We report a case of Brown tumor at T2 vertebra causing acute spinal cord compression in a patient with CRF.

Method: A 33-year-old male presented with back pain and paraparesis. The paraparesis was present for 20 days getting worse the last 3 days. The patient was on hemodialysis for the past ten years due to CRF. On examination, his power was 3/5 paraparesis and proprioception was normal. His reflexes were normal. The CT of the spine revealed an expansible bony lesion within the posterior elements and corpus of T2. The lesion extended to the epidural space, displacing the thecal sac and causing cord compression. At surgery, the lesion was found to be brown/red, soft in consistency and relatively avascular with a distinct surrounding plane. The involved lamina and corpus were excised and the theca decompressed. We did spinal instrumentation put a bone graft to the corpus of T2. The diagnosis of Brown tumor was confirmed by pathology.

Results: The patient had an uncomplicated post-operative recovery. The patient could walk with a support after the operation. Medical treatment was given and the patient had no symptoms due to hyperparathyroidism after 6 months follow-up.

Conclusions: Brown tumors can occur as solitary or multiple lesions. However, it is not a true neoplasm but rather a reactive osteolytic lesion of bone and may mimic other diseases such as giant cell tumors, multiple bone metastasis or multiple myeloma. Surgery is occasionally indicated if the lesion is located in a critical anatomical site or it causes a neurological deficit. It is aimed not only at decompressing the cord but also for providing spinal stability. In the spinal bone masses, we should consider benign lesions as well as malign lesions in the differential diagnosis.