A CASE OF PRIMARY HYPERPARATHYROIDISM COMPLICATED WITH A BROWN TUMOR MIMICKING METASTATIC BONE DISEASE

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  • 骨悪性腫瘍と鑑別困難であったbrown tumorを伴う原発性上皮小体機能亢進症の1例

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Abstract

A 48-year-old man visited another hospital because of a left knes joint pain, and was found to have a destructive osseous tumor in the left femur by plain X-ray, CT and MRI findings. Bone scintigraphy showed multiple scattered increased uptake areas. He was referred to the hospital. The femoral tumor was removed with a suspicion of some metastatic bone disease. But histopathologically, a brown tumor complicated with primary hyperparathyroidism was most probable. Blood chemical examination showed elevated levels of serum calcium, ALP and PTH-intact, and normal level of PTH-rH. The location of parathyroid tumor could be comfirmed by imagings such as ultrasonography, CT and subtraction scintigraphy of the neck. The parathyroid tumor was resected en bloc. Microscopically, the resected parathyroid tumor was benign adenoma. Measurements of PTH-intact and PTH-rH are valuable when diagnostic imagings are imposible to differentiate between metastatic bone disease with hypercalcemia and brown tumor complicated with primary hyperparathyroidism.

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