
C. SZEVERÉNYI ET AL.
346
causing compressive symptoms [4,6]. Furthermore, as in
our case, the tumor has a potential to become so large
that it makes everyday life difficult.
PTH also has an effect on the kidneys as it increases
phosphate excretion. Therefore, hypersecretion of PTH
can be inhibited by eliminating phosphate excess. It can
be achieved by oral antacids, dietetic restrictions and
peritoneal dialysis or haemodialysis [4,10,11,12]. How-
ever, after a certain period of time, the enlarged parathy-
roid gland might not react to the fluctuant serum calcium
level, therefore some degree of autonomous glandular
function develops [5,13]. When this occurs, conservative
treatment cannot prevent progressive bone resorption,
hypercalcaemia and metastatic calcifications anymore. In
these cases subtotal parathyroidectomy may be effective,
although secondary hyperparathyroidism might recur,
due to the presence of any residual parathyroid gland
tissue [4]. In our case, even though parathyroidectomy
was performed, serum PTH levels remained high (PTH:
206.1 pmol/L). This arose the suspicion the presence of
an autonomous functioning, ectopic parathyroid tissue in
the persistent thymus or somewhere else in the body,
causing hypersecretion of PTH.
Based on the literature reviewed, the incidence of
brown tumor involving bones is between 1.5% - 13%
among patients suffering from chronic renal failure [4,6,
7]. Furthermore, the lesion develops most frequently in
the pelvic bones, costae, sternum, maxillary sinus, man-
dible and in the femur [3,4,7,8,12,13]. The presence of
brown tumor in the vertebral column is rare. After re-
viewing the literature since 1974, only 19 similar cases
were published, with 8 patients having primary and 11
having secondary hyperparathyroidism as the underlying
cause of the disease [1,4-7,12,14]. We did not find a sin-
gle case of brown tumor developing from a vertebra of a
child and reaching such an enormous size. The signifi-
cance of osteitis fibrosa cystica involving th e verteb rae is
that it may cause the pathologic fractures of the vertebrae
or it may invade the spinal canal causing the compres-
sion of the spinal cord [1,4-7,12,14].
5. Conclusions
Our publication focused on the diagnosis, adequate
treatment and the prevention of possible complications of
brown tumors, which manifested as a divers multi-local
disease in our case. Brown tumor is a complication of
chronic renal failure and even though brown tumor has
become very rare nowadays, one has to think of it in pa-
tients suffering from chronic renal failure, and especially
in those cases in which the metabolic balance cannot be
achieved by conservative methods. In certain cases sur-
gical excision or spine-stabilizing intervention may be-
come necessary due to the localization or the size of the
tumor. In our case, finding and removing the suspected
ectopic parathyroid tissue and completing the kidney
transplantation may bring significan t improvement to the
patient’s state of health.
6. References
[1] S. D. Ashebu, M. H. Dahniya, S. A. Muhtaseb and P.
Aduh, “Unusual Florid Skeletal Manifestations of Pri-
mary Hy perparat hyroidi sm,” Skeletal Radiology, Vol. 31,
No. 12, 2002, pp. 720-723.
doi:10.1007/s00256-002-0578-9
[2] M. E. Bohlman, Y. C. Kim, J. Eagan and E. K. Spees,
“Brown Tumor in Secondary Parathyroidism Causing
Acute Paraplegia,” American Journal of Medicine, Vol.
81, No. 3, 1986, pp. 545-547.
doi:10.1016/0002-9343(86)90312-8
[3] H. Dursun, O. Kucukosmanoglu, A. Noyan, N. Ozbarlas,
M. Buyukcelik, M. Soran, A. K. Bayazit and A. Anarat,
“Mitral Annular Calcification and Brown Tumor of the
Rib in a Child with Chronic Renal Failure,” Pediatric
Nephrology, Vol. 20, No. 5, 2005, pp. 673-675.
doi:10.1007/s00467-004-1721-8
[4] K. Fineman, P. Johnson, P. L. Di-Patre and H. Sandhu,
“Chronic Renal Failure Causing Brown Tumors and
Myelopathy. Case Report and Review of Pathophysiol-
ogy and Treatment,” Journal of Neurosurgery, Vol. 90,
No. 4, 1999, pp. 242-246.
[5] A. O. Mustonen, M. J. Kiuru, A. Stahls, T. Bohling, A.
Kivioja and S. K. Koskinen, “Radicular Lower Extremity
Pain as the First Symptom of Primary Hyperparathyroid-
ism,” Skeletal Radiology, Vol. 33, No. 8, 2004, pp.
467-472.
[6] F. Tarrass, A. Ayad, M. Benjelloun, A. Anabi, B. Ram-
dani, M. G. Benghanem and D. Zaid, “Cauda Equina
Compression Revealing Brown Tumor of the Spine in a
Long-Term Hemodialysis Patient,” Joint Bone Spine, Vol.
73, No. 6, 2006, pp. 748-750.
doi:10.1016/j.jbspin.2006.01.011
[7] E. Vandenbussche, L. Schmider, C. Mutschler, M. Man,
C. Jacquot and B. Augereau, “Brown Tumor of the Spine
and Progressive Paraplegia in a Hemodialysis Patient,”
Spine, Vol. 29, No. 12, 2004, pp. E251-E255.
doi:10.1097/01.BRS.0000127187.58944.FA
[8] A. Dogan, E. Algun, E. Kisli, M. Harman, M. Kosem and
N. Tosun, “Calcaneal Brown Tumor with Primary Hy-
perparathyroidism Caused by Parathyroid Carcinoma: An
Atypical Localization,” Journal of Foot and Ankle Sur-
gery, Vol. 43, No. 4, 2004, pp. 248-251.
doi:10.1053/j.jfas.2004.05.001
[9] F. Gouin, E. Grimaud, F. Redini, A. Moreau, N. Passuti
and D. Heymann, “Metatarsal Giant Cell Tumors and
Giant Cell Reparative Granuloma Are Similar Entities,”
Clinical Orthopaedics and Related Research, Vol. 416,
2003, pp. 278-284.
doi:10.1097/01.blo.0000093016.90435.f6
Copyright © 2011 SciRes. SS