BROWN TUMOUR DEPOSITS IN THE CERVICAL SPINE
Dr Andrea Huang1, Dr Jeffrey Wong1
1Liverpool Hospital, Sydney, Australia
Background: Secondary hyperparathyroidism is a relatively common occurrence in chronic disease. Brown tumour is a rare benign lesion of the bone with an incidence up to 13% of secondary hyperparathyroidism with rare involvement of the cervical spine. Here we present the case of a patient with Brown tumour involving his cervical spine.
Case report: A 67 year old gentleman presented with acute pain crisis and was found on a CT of his spine to have a destructive soft tissue lesion involving C7 thought initially to be an osteosarcoma. This was on a background medical history of end stage renal failure secondary to hypertension on thrice weekly haemodialysis, previous tuberculosis, hypertension, previous smoking, and known secondary hyperparathyroidism with PTH (Parathyroid hormone) level 204 pmol/L. He underwent C7 decompression and posterolateral fusion within a month. A nuclear medicine bone scan done afterwards demonstrated abnormally increased osteoblastic activity all over the body with progression from a CT scan in August 2023. Intra-operative biopsies from the lesion demonstrated giant cell rich lesions most consistent with brown tumour of hyperparathyroidism. He was commenced on high dose denosumab 360mg two weeks apart, cinacalcet, calcitriol, and dialysed with a high calcium bath after denosumab for 3 weeks.
Conclusions: Brown tumours of hyperparathyroidism are a rare occurrence, with an even rarer location being the cervical spine. Whilst most of the time differentials would include aggressive malignancies, one of the other differentials to consider in the context of known hyperparathyroidism would be that of Brown tumours, a benign entity.
Biography:
Dr. Andrea Huang is a final year renal advanced trainee within the Central-Southwest-Regional network.