Detaillierte Beitrags-Information
| Beitragstitel | Hyperparathyroidism with ‘swiss cheese skeleton’ in a 21y old man. |
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| Beitragscode | P105 |
| Autoren | |
| Präsentationsform | Poster |
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| Abstract |
Introduction Giant cell tumor (GCT) and brown tumor of hyperparathyroidism (BTH) share similar characteristics containing giant cells and spindle-shaped cells in fibrous matrix, but treatment-wise, both these conditions are totally different. The observation of extensive multiple skeletal osteolyses caused by primary hyperthyroidism is presented to raise attention to consider metabolic causes of space taking lesions of the bone. Methods The 21 year old man experienced a sharp pain while playing squash during a forced rotation of his left knee. MRI showed extensive epimetaphysial multicystic osteolysis of the proximal tibia involving more than 2/3 of the bone cross section with a small impression of the medial plateau. The femur showed extensive metaphysial lesion with similar characteristics involving about ½ of the cross section. The imaging with fluid levels in the cystic areas was suggestive of aneurysmal bone cysts. As multiple aneurysmal bone have not been observed by these authors a whole body FDG-PET was ordered. PET/CT showed similarly extensive, highly FDG-avid, lytic bone lesions around the right knee, the proximal humeri as well as multiple other skeletal lesions. Furthermore bilateral nephrocalcinosis was detected and an FDG-active nodule of about 2 cm diameter dorsal to the right thyroid lobe suggestive of a parathyroid adenoma. Biopsy of tibia and femur revealed a heterogenous proliferation of giant cells compatible with BTH as well as GCT. Serum Parathyroid hormone (PTH) was elevated to 127 pmol/l (normal 1.3-7.6). The adenoma was excised followed by normalization of the PTH. Results PET-CT at 10 months showed remineralization and normalization of FDG-activity, X-Ray at 16 months complete sclerozisation of the formerly osteolytic regions. Discussion Biopsy could have misled to the diagnosis of a GCT of bone. The PET/CT besides depicting the "swiss cheese pattern" of bone lesions and FDG-activity in the parathyroid led to the diagnosis of hyperparathyroidism. Conclusion We wish to stress to raise following questions before biopsy of bone lesion1: - Originating in bone (primary bone tumor) ? - Metastasis ? - Metabolic cause (hyperparathyroidism, VitD aberration, other endocrine active tumor eg. phosphaturic) ? - Hematogenous (chloroma, lymphoma etc) ? - Infection? 1, Exner G.U., Kurrer M.O., Mamisch-Saupe N., Cannon S.R.: The tactics and technique of musculoskeletal biopsy. EFORT Open Rev 2017;2:51-57 |