Images in Clinical Medicine

Brown Tumor in End-Stage Renal Disease

George M. Nassar, M.D., and Juan Carlos Ayus, M.D.

N Engl J Med 1999; 341:1652November 25, 1999

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Figure 1 A 62-year-old man with end-stage renal disease from hypertensive nephrosclerosis that had been treated by hemodialysis for 14 years presented to the emergency room with a productive cough and fever, from which he recovered. A chest film showed right hilar prominence and pleural-based masses (arrows in Panel A), with destructive changes in the adjacent ribs on the left. The cardiac silhouette, pulmonary vasculature, and position of a LeVeen shunt placed for recurrent dialysis-associated ascites were unchanged from a previous chest film. Computed tomography of the chest showed mild mediastinal adenopathy and multiple expansile lytic lesions of the ribs (Panel B), the largest of which was 7 cm in diameter (arrow). Biopsy of a rib lesion revealed dense infiltration of the marrow space by reactive fibroblastic tissue and scattered multinucleated, osteoclastic giant cells (arrows in Panel C; hematoxylin and eosin, ×500). Reactive woven bone and hemosiderin deposits were seen within the fibrous tissue. These histopathological findings are characteristic of brown tumor, a focal lesion of bone caused by hyperparathyroidism. Hemorrhages, with accumulation of hemosiderin within the vascularized fibrous tissue, are common and give the lesion its reddish-brown color. This patient had had symptomatic secondary hyperparathyroidism with diffuse skeletal pain, hypercalcemia, and high serum parathyroid hormone concentrations. Two attempts at surgical parathyroidectomy had been unsuccessful, and he had declined further surgery. At the time of the rib biopsy, he still had hypercalcemia and hyperparathyroidism despite intermittent parenteral treatment with calcitriol.

George M. Nassar, M.D.
Juan Carlos Ayus, M.D.
Baylor College of Medicine, Houston, TX 77030

Citing Articles (5)

Citing Articles

1. 1

   H. Resic, F. Masnic, N. Kukavica, G. Spasovski. (2011) Unusual clinical presentation of brown tumor in hemodialysis patients: two case reports. International Urology and Nephrology 43:2, 575-580
   CrossRef

2. 2

   Goce Spasovski, Jelka Masin-Spasovska, Daniel Gjurchinov. (2009) Successful treatment of severe secondary hyperparathyroidsm (Brown tumor) by kidney transplantation and pulses of oral calcitriol. Clinical Transplantation 23:3, 426-430
   CrossRef

3. 3

   Nicola Di Daniele, Stefano Condò, Michele Ferrannini, Marta Bertoli, Valentina Rovella, Laura Di Renzo, Antonino De Lorenzo. (2009) Brown Tumour in a Patient with Secondary Hyperparathyroidism Resistant to Medical Therapy: Case Report on Successful Treatment after Subtotal Parathyroidectomy. International Journal of Endocrinology 2009, 1-3
   CrossRef

4. 4

   Manabu Hoshi, Masatsugu Takami, Michiko Kajikawa, Kazuhiro Teramura, Takashi Okamoto, Ikuhisa Yanagida, Akira Matsumura. (2008) A case of multiple skeletal lesions of brown tumors, mimicking carcinoma metastases. Archives of Orthopaedic and Trauma Surgery 128:2, 149-154
   CrossRef

5. 5

   J. Carreres, F.J. Irurzune, I. Herraiz. (2007) Casos en Imagen: 3.—Tumores pardos en un paciente con insuficiencia renal crónica e hiperparatiroidismo secundario. Radiología 49:6, 406-450
   CrossRef