Multiple brown tumor in late adolescence mimicking bone metastasis: A challenging case report

Abstract

Brown tumors, resulting from elevated osteoclast activity, are uncommon skeletal symptoms of hyperparathyroidism. Because of their similar characteristics, it is challenging to differentiate these tumors from multiple myeloma or osteolytic metastases. A 24-year-old female with a painful lump in her left thigh and arm in the past 10 months. The patient reported a history of left femoral bone fracture over a year ago due to low-impact trauma. Plain radiograph images and chest MSCT showed osteolytic lesions at the skull, ribs, and extremities, followed by increased Tc99 bone scan image uptake. Thyroid ultrasound and cervical MSCT showed parathyroid mass. Biochemical and pathologic examination supported the diagnosis of brown tumor. A multidisciplinary approach, including clinical evaluation, biochemical assessment, pathological examination, and advanced imaging modalities such as CT scan, MRI, and bone scintigraphy, is necessary for the differential diagnosis of brown tumors from bone metastasis. Medical history, PTH, calcium levels in the blood, and additional systemic symptoms can all be used to help distinguish between the 2 disorders. The clinical presentation and imaging findings of brown tumors may mimic bone metastasis, necessitating comprehensive evaluation. Multidisciplinary collaboration plays a vital role in reaching an accurate diagnosis. Increased awareness of brown tumors as a potential mimic of bone metastasis may help prevent misdiagnosis and ensure optimal care for patients presenting with osteolytic bone lesions associated with hyperparathyroidism.

Keywords

• Brown tumor
• Bone metastasis
• Primary hyperparathyroidism
• Bone scintigraphy