Multiple Brown Tumors in Parathyroid Carcinoma Mimicking Metastatic Bone Disease

• Published in: Clinical nuclear medicine 1997-10, Vol.22 (10), p.691-694
• Main Authors: PAI, MOONSUN, PARK, CHAN H, KIM, BYOUNG-SUCK, CHUNG, YOON-SOK, PARK, AND HEE-BOONG
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Bone Diseases - diagnostic imaging; Bone Diseases - etiology; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - secondary; Carcinoma - complications; Carcinoma - diagnostic imaging; Carcinoma - secondary; Endocrinopathies; Female; Follow-Up Studies; Granuloma, Giant Cell - diagnostic imaging; Granuloma, Giant Cell - etiology; Humans; Hyperparathyroidism - diagnosis; Hyperparathyroidism - etiology; Leg; Malignant tumors; Medical sciences; Osteitis Fibrosa Cystica - diagnostic imaging; Osteitis Fibrosa Cystica - etiology; Parathyroid Hormone - blood; Parathyroid Neoplasms - complications; Parathyroidectomy; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thyroid Gland - diagnostic imaging; Thyroidectomy; Whole-Body Counting
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/00003072-199710000-00006

An unusual case of multiple brown tumors due to parathyroid carcinoma is reported. The patient presented with lower leg pain. Plain radiographs demonstrated multiple lytic lesions of the lower legs and a Tc-99m MDP bone scan depicted multiple areas of increased uptake suggesting skeletal metastases. Tc-99m sestamibi tumor scintigraphy showed multiple sites of tumor uptake in bones and a large area of increased uptake with a cystic component in the right lower pole of the thyroid gland. An open biopsy from the right tibial lesion revealed a brown tumor. A large parathyroid carcinoma with a necrotic cyst was removed. After parathyroidectomy and right thyroid lobectomy, the patient became free of bone pain and serum PTH levels normalized. A 9-month follow-up Tc-99m MDP bone scan demonstrated less intense uptake in the pelvis, tibia, and fibulae. Nine-month follow-up tumor imaging with Tc-99m MIBI revealed disappearance of the preoperative uptake of multiple brown tumor.