title: Brown tumor of the spine in patients with primary hyperparathyroidism.
abstract: METHODS
  Retrospective case series and literature review.
  
  
  OBJECTIVE
  To describe our experience in diagnosis and management of patients with spine brown tumor (osteitis fibrosa cystica) as the initial manifestation of primary hyperparathyroidism and also to review the pertinent literature.
  
  
  BACKGROUND
  The spine can be involved through reparative processes such as giant cell reparative granuloma and brown tumor, which lead to formation of lesions that can simulate tumors on neuroimaging. Brown tumor, an uncommon focal giant cell lesion, is a nonneoplastic and reactive process due to bone resorption and localized osseous lesion caused by primary or secondary hyperparathyroidism.
  
  
  METHODS
  Among the cases of spine giant cell lesions treated surgically by the authors (2000-2013), there were 4 cases of spine brown tumor in patients with primary hyperparathyroidism. Clinical, radiological, histopathologic, and surgical data of these 4 cases were collected, and the patients were followed from 5 to 7 years after the surgical intervention.
  
  
  RESULTS
  There were 2 male and 2 female patients with age range of 16 to 52 years. The lesions were located in cervical (1 case), thoracic (1 case), and lumbar (2 cases) spine regions. Clinical presentations included neck and low back pain, radicular pain, paraparesis, and sphincter dysfunction. Surgical removal of the spine lesions was achieved in all cases. Spine fusion and instrumentation was done in 3 cases. Parathyroidectomy was performed in all 4 cases.
  
  
  CONCLUSIONS
  Spine involvement with brown tumor in patients with primary hyperparathyroidism is rare and may be the first manifestation of hyperparathyroidism. Brown tumor should be differentiated from other giant cell lesions involving the spine. Long-term surgical outcome was satisfactory with no recurrence.
  
  
  METHODS
  4.
authors.affiliation: From the Department of Neurosurgery, Arad Hospital, Tehran, Iran.
authors.forename: Mahmoud Reza
authors.initials: MR
authors.lastname: Khalatbari
authors.forename: Yashar
authors.initials: Y
authors.lastname: Moharamzad
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006101:Granuloma, Giant Cell / Q000209:etiology / Q000601:surgery*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010002:Osteitis Fibrosa Cystica / Q000209:etiology / Q000601:surgery*; D016105:Parathyroidectomy; D012189:Retrospective Studies; D012196:Review Literature as Topic; D013122:Spinal Diseases / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome