Diaphyseal Femoral Fracture Associated with Hyperparathyroidism and Brown Tumor with Sclerotic Bone Response to Parathyroidectomy

Brown tumor is a rare complication of longstanding hyperparathyroidism(HPT). The pathology is well defined but the radiologic appearance has previously been described as lytic with rare reports of sclerotic lesions after therapy. Brown tumors can affect the mandible, maxilla, ribs, clavicles and rarely long bones. When multiple, these lesions may mimic malignancy, metastatic to bone. We present a 35 year-old East Indian woman who presented with a pathological, atraumatic right femoral diaphyseal fracture. Curettings of the femoral shaft at the time of surgical nailing showed “brown tumor of bone” but did not show malignant change. Subsequent isotope bones scan showed multiple skeletal areas of uptake in proximal femur, and T12 vertebra. Imaging studies showed lytic lesions at these locations. Parathyroidectomy surgery yielded a 1.2cm solitary parathyroid adenoma. There was postoperative normalization of hypercalcemia and elevated PTH levels. Subsequent radiographs and DXA BMD studies showed an intense blastic response at the sites of prior bone scan uptake and radiographic lytic lesions. We described an atypical diaphysieal femoral fracture associated with hyperparathyroidism and solitary parathyroid adenoma. Surgical cure of her primary hyperparathyroidism resulted in an atypical blastic appearance of the previously lytic lesions. These abnormalities might be easily confused with bisph

Author(s): Fahad Alshahrani, Mussa Almalki, Khalid Khashoggi, Juliet Luna-Algoso, David Kendler

Abstract | Full-Text | PDF

Share this