Clinical Rheumatology

, Volume 30, Issue 3, pp 419–424

Brown tumor of the cervical spine: a case report and review of the literature

  • Lourdes Mateo
  • Ana Massuet
  • Montserrat Solà
  • Ricard Pérez Andrés
  • Eva Musulen
  • M. Carmen Sánchez Torres
Case Based Review

DOI: 10.1007/s10067-010-1608-y

Cite this article as:
Mateo, L., Massuet, A., Solà, M. et al. Clin Rheumatol (2011) 30: 419. doi:10.1007/s10067-010-1608-y

Abstract

Brown tumors (BT) are benign focal bone lesions that may appear in the context of primary and secondary hyperparathyroidism (HPT). Involvement of the spine is exceedingly rare. We present a case of brown tumor involving the cervical spine, the third reported in the literature. In the literature review (until August 2010), we found nine cases of spinal BT in primary HPT and 14 cases in secondary HPT. Fifteen patients (65%) had evidence of spinal cord compression. A 34-year-old woman on long-term hemodialysis, with secondary HPT, presented with a 9-month history of persistent neck pain. Radiographs of the cervical spine revealed an expansive osteolytic lesion in the posterior arch of the second cervical vertebra. MR imaging revealed an expansive mass on C2 affecting the vertebral body, odontoid process, right pedicle, laminas, and spinous process; there were no signs of spinal edema. A CT-guided needle biopsy of the lesion showed destruction of trabecular bone, infiltration of the fibroblastic cells, and abundant osteoclast-like multinucleated giant cells with hemorrhage and hemosiderin pigment, and the diagnosis of brown tumor was made. Cervical pain disappeared within a few days of parathyroidectomy, and rapid remineralization of C2 was evident within a few months. BT must always be considered in the context of hyperparathyroidism and osteolytic lesions. Vertebral BT can be particularly devastating due to medullar compression symptoms. Regression or complete disappearance of these lesions after parathyroidectomy is common, but prompt surgical decompression is necessary in case of medullar compression symptoms.

Keywords

Brown tumorCord compressionGiant cell tumorHyperparathyroidismOsteitis fibrosa cystica

Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  • Lourdes Mateo
    • 1
  • Ana Massuet
    • 2
  • Montserrat Solà
    • 3
  • Ricard Pérez Andrés
    • 4
  • Eva Musulen
    • 5
  • M. Carmen Sánchez Torres
    • 2
  1. 1.Rheumatology ServiceH. Germans Trias i PujolBadalonaSpain
  2. 2.Magnetic ResonanceH. Germans Trias i PujolBadalonaSpain
  3. 3.Nuclear Medicine ServiceH. Germans Trias i PujolBadalonaSpain
  4. 4.RadiologyH. Germans Trias i PujolBadalonaSpain
  5. 5.PathologyH. Germans Trias i PujolBadalonaSpain