Brown tumors are osteoclastic, benign lesions characterized by fibrotic stroma, intense vascularization and multinucleated giant cells. They are the terminal expression of the bone remodelling process occurring in advanced hyperparathyroidism. Nowadays, due to earlier diagnosis, primary hyperparathyroidism keeps few of the classical manifestations and brown tumors are definitely unexpected. Thus, it may happen that they are misdiagnosed as primary or metastatic bone cancer. Besides bone imaging, endocrine evaluation including measurement of serum parathyroid hormone and calcium (Ca) levels supports the pathologist to address the diagnosis. Herein, a case of multiple large brown tumors misdiagnosed as a non-treatable osteosarcoma is described, with special regards to diagnostic work-up. After selective parathyroidectomy, treatment with denosumab was initiated and a regular follow-up was established. The central role of multidisciplinary approach involving pathologist, endocrinologist and oncologist in the diagnostic and therapeutic work-up is reported. In our opinion, the discussion of this case would be functional especially for clinicians and pathologists not used to the differential diagnosis in uncommon bone disorders.

When primary hyperparathyroidism comes as good news

Gallo, D
Writing – Original Draft Preparation
;
Rosetti, S
Writing – Original Draft Preparation
;
Pinotti, G
Supervision
;
Patera, B
Data Curation
;
Gentile, L
Data Curation
;
Tanda, M. L. P
Writing – Review & Editing
;
Bartalena, L
Writing – Review & Editing
;
Piantanida, E
Writing – Review & Editing
2020

Abstract

Brown tumors are osteoclastic, benign lesions characterized by fibrotic stroma, intense vascularization and multinucleated giant cells. They are the terminal expression of the bone remodelling process occurring in advanced hyperparathyroidism. Nowadays, due to earlier diagnosis, primary hyperparathyroidism keeps few of the classical manifestations and brown tumors are definitely unexpected. Thus, it may happen that they are misdiagnosed as primary or metastatic bone cancer. Besides bone imaging, endocrine evaluation including measurement of serum parathyroid hormone and calcium (Ca) levels supports the pathologist to address the diagnosis. Herein, a case of multiple large brown tumors misdiagnosed as a non-treatable osteosarcoma is described, with special regards to diagnostic work-up. After selective parathyroidectomy, treatment with denosumab was initiated and a regular follow-up was established. The central role of multidisciplinary approach involving pathologist, endocrinologist and oncologist in the diagnostic and therapeutic work-up is reported. In our opinion, the discussion of this case would be functional especially for clinicians and pathologists not used to the differential diagnosis in uncommon bone disorders.
2020; Alkaline phosphatase; Arthralgia; Bone; Bone biopsy; Bone mineral density; Bone scintigraphy; Brown tumour; CT scan; Calcium (serum); Calcium (urine); Calcium carbonate; Cholecalciferol; Creatinine; Denosumab; Error in diagnosis/pitfalls and caveats; Estimated glomerular filtration rate; Female; Fluid repletion; General practice; Geriatric; Haematoxylin and eosin staining; Histopathology; Hypercalcaemia; Hyperparathyroidism (primary); Hypocalcaemia; Immunohistochemistry; Italy; June; Neck mass; Oncology; Osteoarthritis; Osteopenia; Osteoporosis; PTH; Parathyroid; Parathyroid adenoma; Parathyroidectomy; Phosphate (urine); Radiology/Rheumatology; Sestamibi scan; Surgery; Ultrasound scan; Vitamin D; White; X-ray
Gallo, D; Rosetti, S; Marcon, I; Armiraglio, E; Parafioriti, A; Pinotti, G; Perrucchini, G; Patera, B; Gentile, L; Tanda, M. L. P; Bartalena, L; Piantanida, E
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11383/2097518
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