A BONE LESION MIMICKING BROWN TUMOR IN AN ATYPICAL LOCALIZATION IN PATIENT WITH MEDIASTINAL PARATHYROID ADENOMA: CASE REPORT

Year 2010, Volume: 4 Issue: 3, 137 - 141, 22.11.2010

Hüsniye Başer

Abstract

Parathyroid adenomas in ectopic localizations constitute a 4-16 % of all primer hyperparathyroidism cases. “Brown tumor” is a rare condition related to primer hyperparathyroidism. A 33 year old man with a complaint of joint pain consulted to our policlinic. He had nephrolithiasis. In the laboratory tests, it was seen that his calcium: 11.5 mg/dl, phosphorus. 2.3 mg/dl, alkaline phosphatase: 569 U/l and parathormone: 1812 pg/ml; calcium extraction in 24 hour urine analyses was calculated as 425 mg/day. Also, there were no images suggesting an adenoma in parathyroid ultrasound imaging. By Tc-99m sestamibi scintigraphy, a lesion was detected at the mediasten with an increased tracer uptake that even persisted in the late phase images; and it was evaluated as an ectopic parathyroid adenoma. In further examination by thorax CT scan; a solid lesion was demonstrated at anterior mediasten which was compatible with parathyroid adenoma. Also, cystic bone lesions were detected at the right humerus head and clavicle, and an expansile lytic lesion at the right third costa (a Brown tumor?). However, no primary malignancies were determined that might have caused these bone findings. Therefore, it was thought that these lesions might be related to osteitis fibrosa cystica which develops secondary to primary hyperparathyroidism. According to these findings, our patient has undergone a mediastinal mass excision surgery -with median sternotomy-. The histopathological examination revealed that this mediastinal mass lesion was a parathyroid adenoma.

Keywords

Primer hiperparatiroidi, mediastinal paratiroid adenomu, Brown tümör, Primary hyperparathyroidism, mediastinal parathyroid adenoma, brown tumor

MEDİASTİNAL PARATİROİD ADEN0MLU BİR HASTADA ATİPİK LOKALİZASYONDA BROWN TÜMÖR BENZERİ KEMİK LEZYONU: OLGU SUNUMU

Abstract

Ektopik yerleşimli paratiroid adenomları tüm primer hiperparatiroidi olgularının % 4-16’sını oluşturmaktadır. Brown tümör primer hiperparatiroidiye bağlı nadir görülen durumdur. 33 yaşındaki erkek hasta eklem ağrısı yakınması ile polikliniğimize başvurdu. Nefrolitiazis öyküsü bulunmaktaydı. Laboratuar incelemesinde; kalsiyum: 11.5 mg/dl, fosfor: 2.3 mg/dl, alkalen fosfataz: 569 U/l, paratiroid hormon: 1812 pg/ml, 24 saatlik idrar tetkikinde kalsiyum atılımı: 425 mg/gün ölçüldü. Paratiroid ultrasonografisinde adenom ile uyumlu görünüm izlenmedi. Tc-99m sestamıbı sintigra-fisinde mediastende geç görüntülerde sebat eden aktivite tutulumu ektopik paratiroid adenomu ile uyumlu olarak değerlendirildi. Toraks tomografisinde; anterior mediastende paratiroid adenomuy-la uyumlu solid lezyon, sağ humerus başında ve sağ klavikulada kistik lezyonlar ile sağ 3. kosta lateralinde litik görünümlü ekspansil lezyon (brown tümör?) görüntülendi. Hastada kemik bulgularına neden olacak primer malignite saptanmadı. Bu nedenle kemiklerdeki lezyonların primer hiperparatiroidiye sekonder gelişen osteitis fıbroza sistikaya bağlı olduğu düşünüldü. Hastaya median stemotomi ile anterior mediastinal kitle eksizyonu operasyonu uygulandı. Histopatolojik inceleme paratiroid adenomu ile uyumlu idi.

Dr. Hüsniye BAŞER,
Dr. Abbas Ali TAM,
Dr. Sedat CANER,
Dr. Burcu UZUN,
Dr. Nurettin KARAOGLANOGLU,
Dr. Reyhan ERSOY,
Dr. Bekir ÇAKIR

Keywords

Primer hiperparatiroidi, mediastinal paratiroid adenomu, Brown tümör

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