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

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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.

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Authors and Affiliations

  1. Rheumatology Service, H. Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Spain

    Lourdes Mateo

  2. Magnetic Resonance, H. Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Spain

    Ana Massuet & M. Carmen Sánchez Torres

  3. Nuclear Medicine Service, H. Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Spain

    Montserrat Solà

  4. Radiology, H. Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Spain

    Ricard Pérez Andrés

  5. Pathology, H. Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Spain

    Eva Musulen

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  1. Lourdes Mateo
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  2. Ana Massuet
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  3. Montserrat Solà
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  4. Ricard Pérez Andrés
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  5. Eva Musulen
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  6. M. Carmen Sánchez Torres
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Correspondence to Lourdes Mateo.

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Mateo, L., Massuet, A., Solà, M. et al. Brown tumor of the cervical spine: a case report and review of the literature. Clin Rheumatol 30, 419–424 (2011). https://doi.org/10.1007/s10067-010-1608-y

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  • DOI: https://doi.org/10.1007/s10067-010-1608-y

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