Brown tumor complicating end-stage kidney disease.

Clinical Nephrology. Case Studies Pub Date : 2020-10-12 eCollection Date: 2020-01-01 DOI:10.5414/CNCS110195
Michael Wiederkehr
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Abstract

Longstanding, severe hyperparathyroidism (HPT) can lead to the formation of "brown tumors". A brown tumor is a radiolucent bone lesion that is locally destructive; it is not a neoplasm, but rather a stromal mass consisting of fibrous tissue, poorly mineralized woven bone, and supporting vasculature. These tumors are a rare complication of advanced primary or secondary HPT. We present a young female with chronic kidney disease (CKD) on hemodialysis with uncontrolled secondary HPT (SHPT). The patient presented with progressive lower extremity weakness and back pain. CT imaging showed multiple lytic bone lesions involving several ribs and the spine. Subsequent MRI imaging of the thoracic and lumbar spine confirmed expansile bone lesions consistent with brown tumors. One mass protruded into the spinal canal causing severe stenosis at T3 with underlying cord edema. The other lesion at T12 caused only moderate spinal canal stenosis. Our patient underwent urgent neurosurgical resection of the tumor at T3 followed by subtotal parathyroidectomy (PTX).

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并发终末期肾病的棕色肿瘤。
长期严重的甲状旁腺功能亢进症(HPT)可导致 "褐色瘤 "的形成。棕色瘤是一种局部具有破坏性的放射性骨病变;它不是肿瘤,而是由纤维组织、矿化度低的编织骨和支持血管组成的基质肿块。这些肿瘤是晚期原发性或继发性 HPT 的罕见并发症。我们为您介绍一位年轻女性患者,她患有慢性肾脏病(CKD),正在进行血液透析,并伴有不受控制的继发性 HPT(SHPT)。患者出现进行性下肢无力和背痛。CT 成像显示多处骨溶解性病变累及多根肋骨和脊柱。随后进行的胸椎和腰椎核磁共振成像检查证实,扩张性骨病变与棕色肿瘤一致。其中一个肿块突入椎管,导致 T3 椎管严重狭窄,并伴有潜在的脊髓水肿。另一个位于T12的病变仅造成中度椎管狭窄。我们的患者接受了紧急神经外科手术,切除了T3处的肿瘤,随后进行了甲状旁腺次全切除术(PTX)。
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