NORMOKALSEMİ İLE SEYREDEN VE METASTATİK KEMİK HASTALIĞINI TAKLİT EDEN BİR BROWN TÜMÖRÜ OLGUSU

Year 2005, Volume: 6 Issue: 3, 33 - 36, 01.12.2005

Nezih Meydan Mediha Ayhan Sabri Barutca Engin Güney Şükrü Boylu

Abstract

Kemik sintigrafisi oldukça yaygın kullanılan bir tarama yöntemidir. Brown tümör ilerlemiş hiperparatiroidinin
oldukça nadir görülen bir bulgusudur. Primer hipertroidi, hiperkalsemi ve hipofosfatemi ile seyreden bir
hastalıktır ve sintigrafik görüntülemede metastatik kemik hastalığını taklit edebilir. Biz bu yazımızda yaygın
kemik ağrısı yakınması ile başvuran ve çekilen tüm vücut kemik sintigrafisinde kostalarda ve sol femur
proksimalinde metastatik olarak değerlendirilen aktivite artışları saptanan 65 yaşında bir kadın hastayı
sunuyoruz. Ancak, yapılan tetkiklerinde serum kalsiyum ve fosforu normal sınırlardaydı. Paratiroid
sintigrafisinde sağ alt bölgede paratiroid adenomu ile uyumlu artmış tutulum saptandı ve paratiroidektomi
yapıldı

Keywords

normokalsemi, metastaz, Brown tümörü

Normocalcemic Brown Tumor Mimicking Metastatic Bone Disease: Report of a Case

Abstract

Bone scintigraphy is a commonly used screening tool in medicine. Brown tumor can be a rare skeletal manifestation of advanced hyperparathyroidism. Primer hyperparathyroidism presents with hypercalcaemia and hypophosphatemia and it can mimic metastatic bone disease. We described a 65-year-old woman who has referred for generalized pain exacerbating on movement and increased uptake in the ribs, proximal of the left femur neck suggestive of metastatic lesions by whole body bone scintigraphy. However, serum calcium and phosphorus levels were normal. Parathyroid scintigraphy revealed extensive uptake in the right lower neck regions consistent with parathyroid adenoma. Parathyroidectomy was performed.

Keywords

normocalcemia, metastases, Brown tumor

References

• 1. Bringhurst FR, Demay MB, Kronenberg HM. Hypercalcemic disorders. In: Williams Textbook of Endocrinology. Larsen PR, Kronenberg HM, Melmed S, Polonsky KS (eds). 10 edition. Philadelphia: Elsevier Science, 2003:1323-1340.
• 2. Bassler T, Wong ET, Brynes RK. Osteitis fibrosa cystica simulating metastatic tumor. An almostforgotten relationship.Am J Clin Pathol 1993;100:697- 700.
• 3. Heath H III, Hodgson SF, Kennedy MA. Primary hyperparathyroidism: incidence, morbidity, and potential economic impact in a community. New Engl J Med 1990; 302:189-193.
• 4. Gupta A, Horattas MC, Moattari AR, Shorten SD. Disseminated brown tumor from hyperparathyroidism masquerading as metastatic cancer: a complication of parathyroid carcinoma.Am Surg 2001; 67:951-955.
• 5. Keyser JS, Postma GN. Brown tumor of the mandible. Am J Otolaryngol. 1996; 17:407-410.
• 6. Polat P, Kantarcı M, Alper F, Koruyucu M, Suma S, Onbaş O. The spectrum of radiographic findings in primary hyperparathyroidism. Clin Imaging 2002; 26:197-205.
• 7. Pai M, Park CH, Kim BS, Chung YS, Park HB. Multiple brown tumors in parathyroid carcinoma mimicking metastatic bone disease. Clin Nucl Med 1997; 22:691-694.
• 8. Emin AH, Süoglu Y, Demir D, Karatay MC. Normocalcemic hyperparathyroidism presented with mandibular brown tumor: report of a case. Auris Nasus Larynx 2004;31:299304.
• 9. Kulak CA, Bandeira C, Voss D, Sobieszczyk SM, Silverberg SJ, Bandeira F, Bilezikian JP. Marked improvement in bone mass after parathyroidectomy in osteitis fibrosa cystica. J Clin Endocrinol Metab 1998; 83:732-735.
• 10. Rybak LD, Rosenthal DI. Radiological imaging for the diagnosis of bone metastases. Q J Nucl Med 2001; 45:53-64.
• 11. Jacobson AF, Stomper PC, Jochelson MS, Ascoli DM, Henderson IC, Kaplan WD. Association between number and sites of new bone scan abnormalities and presence of skeletal metastases in patients with breast cancer. J Nucl Med 1990; 31:387-392.
• 12. Tumeh SS, Beadle G, Kaplan WD. Clinical significance of solitary rib lesions in patients with extra skeletal malignancy. J Nucl Med 1985; 26:1140-1143.
• 13. Rougraff BT, Kneisl JS, Simon MA. Skeletal metastases of unknown origin. J Bone Joint Surg Am 1993; 75:1276.