title: Multiple brown tumors in parathyroid carcinoma mimicking metastatic bone disease.
abstract: 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.
authors.affiliation: Department of Nuclear Medicine, Ajou University Hospital, Suwon, Korea.
authors.forename: M
authors.initials: M
authors.lastname: Pai
authors.forename: C H
authors.initials: CH
authors.lastname: Park
authors.forename: B S
authors.initials: BS
authors.lastname: Kim
authors.forename: Y S
authors.initials: YS
authors.lastname: Chung
authors.forename: H B
authors.initials: HB
authors.lastname: Park
mesh_terms: D000328:Adult; D001847:Bone Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D002277:Carcinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D006101:Granuloma, Giant Cell / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000209:etiology; D007866:Leg; D010002:Osteitis Fibrosa Cystica / Q000000981:diagnostic imaging* / Q000209:etiology; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications*; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate; D017256:Technetium Tc 99m Sestamibi; D013961:Thyroid Gland / Q000000981:diagnostic imaging; D013965:Thyroidectomy; D014915:Whole-Body Counting
chemical_list: D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D013669:Technetium Tc 99m Medronate