Management of brown tumor of spine with primary hyperparathy
A 50-year-old woman was admitted to our hospital complaining left elbow and thoracodorsal pain with the lower limbs weakness for over 1 month. The patient suffered right femoral neck fracture when falling down, and received fracture reduction with internal fixation. Later she was diagnosed as right humerus pathologic fracture and received lesion clearing and plate fixation surgery.

The subsequent pathologic report failed to provide the definite diagnosis. Muscle strength of the upper extremities was 3/5 (left) and the lower was 3/5 (left) and 2/5 (right). Hypotonia were observed in both upper and lower limbs especially lower limbs. Computed tomography (CT) and thoracic magnetic resonance imaging (MRI) showed mass lesion involving the T9 vertebral with expansive growth but not compressing the spinal cord. Positron emission tomography (PET)-CT revealed multifocal lesions with high 18F-fluorodeoxyglucose (18FDG) uptake. PTH was measured as high at 1811 pg/mL (normal, 15–65 pg/mL); serum calcium level was high at 2.61 mmol/L (normal, 2.1–2.55 mmol/L); hemoglobin was low to 45 g/L (normal, 110–155 g/L); erythrocyte sedimentation rate was high at 94 mm/h; osteocalcin was >300 (normal, 11–43 ng/mL).

After admission, blood transfusion was conducted immediately because of severe anemia. A biopsy was performed at the left tibia by confirming the pathologic diagnosis of BT. Since the lesion in the spine did not cause obvious unstable fracture or compression of spinal cord, the patient did not receive spine surgery but was transferred to the endocrinology department for decreasing serum calcium level. The patient received intramuscular injection of 50 IU Miacalcic twice a day and incense of 12.5 μg Calcitonin (Salmon) Nasal Spray once a day. And oral iron supplements were administered due to the iron-deficiency anemia. Chest CT scan showed ectopia parathyroidoma in the anterior mediastinum. After 16 days’ medical treatment, the patient obtained pain relief in the left elbow and thoracodorsal region when discharged.

The blood reexamination showed PTH was 1235 ng/mL, calcium 2.61 mmol/L, and hemoglobin 109 g/L. Surgery was performed later to excise the ectopia parathyroidoma.

At 1-year final follow-up, the patient was able to lead an independent life in her full capacity, even though she occasionally complained mild weakness of lower limbs. As for blood reexamination, the relevant results were normal. The level of PTH was within normal (53 pg/mL) and the level of serum calcium was at 2.28 mmol/L.

Source: Medicine: April 2019 - Volume 98 - Issue 14 - p e15007

Read more: