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Published in: Insights into Imaging 1/2019

Open Access 01-12-2019 | Ultrasound | Educational Review

Imaging of brown tumours: a pictorial review

Authors: Cheng Xie, Maria Tsakok, Nia Taylor, Karen Partington

Published in: Insights into Imaging | Issue 1/2019

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Abstract

Brown tumours do not represent neoplastic process, but they are focal bony lesions due to bone remodelling from either primary or secondary hyperparathyroidism. Their incidence is also low. The current literature on brown tumour is mainly in the form of case reports that focus on single affected sites. This pictorial review describes the full imaging workup and pathway of suspected brown tumour in the setting of both primary and secondary hyperparathyroidism. It aims to illustrate the management strategy to aid both clinicians and radiologists in suspected cases of brown tumour. We highlight the complementary roles that different imaging modalities can play in different settings including the importance of parathyroid ultrasound, 99mTc-sestamibi scintigraphy and SPECT/CT in the localisation of the parathyroid adenoma. We present cases with full clinical and imaging workup in both the acute and chronic setting and scenarios that require exclusion of primary and secondary bone malignancies.
Literature
1.
go back to reference Schweitzer VG, Thompson NW, McClatchey KD (1986) Sphenoid sinus brown tumor, hypercalcemia, and blindness: an unusual presentation of primary hyperparathyroidism. Head Neck Surg 8(5):379–386CrossRef Schweitzer VG, Thompson NW, McClatchey KD (1986) Sphenoid sinus brown tumor, hypercalcemia, and blindness: an unusual presentation of primary hyperparathyroidism. Head Neck Surg 8(5):379–386CrossRef
2.
go back to reference Marini M, Vidiri A, Guerrisi R, Campodonico F, Ponzio R (1992) Progress of brown tumors in patients with chronic renal insufficiency undergoing dialysis. Eur J Radiol 14(1):67–71CrossRef Marini M, Vidiri A, Guerrisi R, Campodonico F, Ponzio R (1992) Progress of brown tumors in patients with chronic renal insufficiency undergoing dialysis. Eur J Radiol 14(1):67–71CrossRef
3.
go back to reference Parisien M, Silverberg SJ, Shane E, Dempster DW, Bilezikian JP (1990) Bone disease in primary hyperparathyroidism. Endocrinol Metab Clin North Am 19(1):19–34CrossRef Parisien M, Silverberg SJ, Shane E, Dempster DW, Bilezikian JP (1990) Bone disease in primary hyperparathyroidism. Endocrinol Metab Clin North Am 19(1):19–34CrossRef
4.
go back to reference Rao P, Solomon M, Avramides A et al (1978) Brown tumors associated with secondary hyperparathyroidism of chronic renal failure. J Oral Surg 36(2):154–159 Rao P, Solomon M, Avramides A et al (1978) Brown tumors associated with secondary hyperparathyroidism of chronic renal failure. J Oral Surg 36(2):154–159
5.
go back to reference Weiss RR, Schoeneman MJ, Primack W, Rozycki D, Bennett B, Greifer I (1980) Maxillary brown tumor of secondary hyperparathyroidism in a hemodialysis patient. JAMA. 243(19):1929–1930CrossRef Weiss RR, Schoeneman MJ, Primack W, Rozycki D, Bennett B, Greifer I (1980) Maxillary brown tumor of secondary hyperparathyroidism in a hemodialysis patient. JAMA. 243(19):1929–1930CrossRef
6.
go back to reference Nassar GM, Ayus JC (1999) Images in clinical medicine. Brown tumor in end-stage renal disease. N Engl J Med 1999;341(22):1652CrossRef Nassar GM, Ayus JC (1999) Images in clinical medicine. Brown tumor in end-stage renal disease. N Engl J Med 1999;341(22):1652CrossRef
7.
go back to reference Grulois V, Buysschaert I, Schoenaers J, Debruyne F, Delaere P, Vander Poorten V (2005) Brown tumour: presenting symptom of primary hyperparathyroidism. B-ENT. 1(4):191–195PubMed Grulois V, Buysschaert I, Schoenaers J, Debruyne F, Delaere P, Vander Poorten V (2005) Brown tumour: presenting symptom of primary hyperparathyroidism. B-ENT. 1(4):191–195PubMed
8.
go back to reference Triantafillidou K, Zouloumis L, Karakinaris G, Kalimeras E, Iordanidis F (2006) Brown tumors of the jaws associated with primary or secondary hyperparathyroidism. A clinical study and review of the literature. Am J Otolaryngol 27(4):281–286CrossRef Triantafillidou K, Zouloumis L, Karakinaris G, Kalimeras E, Iordanidis F (2006) Brown tumors of the jaws associated with primary or secondary hyperparathyroidism. A clinical study and review of the literature. Am J Otolaryngol 27(4):281–286CrossRef
9.
go back to reference Hsieh MC, Ko JY, Eng HL (2004) Pathologic fracture of the distal femur in osteitis fibrosa cystica simulating metastatic disease. Arch Orthop Trauma Surg 124(7):498–501CrossRef Hsieh MC, Ko JY, Eng HL (2004) Pathologic fracture of the distal femur in osteitis fibrosa cystica simulating metastatic disease. Arch Orthop Trauma Surg 124(7):498–501CrossRef
10.
go back to reference Joyce JM, Idea RJ, Grossman SJ, Liss RG, Lyons JB (1994) Multiple brown tumors in unsuspected primary hyperparathyroidism mimicking metastatic disease on radiograph and bone scan. Clin Nucl Med 19(7):630–635CrossRef Joyce JM, Idea RJ, Grossman SJ, Liss RG, Lyons JB (1994) Multiple brown tumors in unsuspected primary hyperparathyroidism mimicking metastatic disease on radiograph and bone scan. Clin Nucl Med 19(7):630–635CrossRef
11.
go back to reference Hoshi M, Takami M, Kajikawa M et al (2008) A case of multiple skeletal lesions of brown tumors, mimicking carcinoma metastases. Arch Orthop Trauma Surg 128(2):149–154CrossRef Hoshi M, Takami M, Kajikawa M et al (2008) A case of multiple skeletal lesions of brown tumors, mimicking carcinoma metastases. Arch Orthop Trauma Surg 128(2):149–154CrossRef
12.
go back to reference Younes NA, Mahafza WS, Agabi SS (2004) Brown tumor of the femur associated with double parathyroid adenomas. Saudi Med J 25(11):1701–1703PubMed Younes NA, Mahafza WS, Agabi SS (2004) Brown tumor of the femur associated with double parathyroid adenomas. Saudi Med J 25(11):1701–1703PubMed
13.
go back to reference Erem C, Hacihasanoglu A, Cinel A et al (2004) Sphenoid sinus brown tumor, a mass lesion of occipital bone and hypercalcemia: an unusual presentation of primary hyperparathyroidism. J Endocrinol Invest 27(4):366–369CrossRef Erem C, Hacihasanoglu A, Cinel A et al (2004) Sphenoid sinus brown tumor, a mass lesion of occipital bone and hypercalcemia: an unusual presentation of primary hyperparathyroidism. J Endocrinol Invest 27(4):366–369CrossRef
14.
go back to reference Guney E, Yigitbasi OG, Bayram F, Ozer V, Canoz O (2001) Brown tumor of the maxilla associated with primary hyperparathyroidism. Auris Nasus Larynx 28(4):369–372CrossRef Guney E, Yigitbasi OG, Bayram F, Ozer V, Canoz O (2001) Brown tumor of the maxilla associated with primary hyperparathyroidism. Auris Nasus Larynx 28(4):369–372CrossRef
15.
go back to reference Gelman R, Gellad FE (1991) Brown tumor of the facial bones. AJNR Am J Neuroradiol 12(6):1179–1181PubMed Gelman R, Gellad FE (1991) Brown tumor of the facial bones. AJNR Am J Neuroradiol 12(6):1179–1181PubMed
16.
go back to reference Keyser JS, Postma GN (1996) Brown tumor of the mandible. Am J Otolaryngol 17(6):407–410CrossRef Keyser JS, Postma GN (1996) Brown tumor of the mandible. Am J Otolaryngol 17(6):407–410CrossRef
17.
go back to reference Johnson NA, Tublin ME, Ogilvie JB (2007) Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol 188(6):1706–1715CrossRef Johnson NA, Tublin ME, Ogilvie JB (2007) Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol 188(6):1706–1715CrossRef
18.
go back to reference Taubman ML, Goldfarb M, Lew JI (2011) Role of SPECT and SPECT/CT in the surgical treatment of primary hyperparathyroidism. Int J Mol Imaging 2011:141593CrossRef Taubman ML, Goldfarb M, Lew JI (2011) Role of SPECT and SPECT/CT in the surgical treatment of primary hyperparathyroidism. Int J Mol Imaging 2011:141593CrossRef
19.
go back to reference Ruda JM, Hollenbeak CS, Stack BC Jr (2005) A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg 132(3):359–372CrossRef Ruda JM, Hollenbeak CS, Stack BC Jr (2005) A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg 132(3):359–372CrossRef
20.
go back to reference Rodgers SE, Hunter GJ, Hamberg LM et al (2006) Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 140(6):932–940; discussion 40-1CrossRef Rodgers SE, Hunter GJ, Hamberg LM et al (2006) Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 140(6):932–940; discussion 40-1CrossRef
21.
go back to reference Bann DV, Zacharia T, Goldenberg D, Goyal N (2015) Parathyroid localization using 4D-computed tomography. Ear Nose Throat J 94(4–5):E55–E57CrossRef Bann DV, Zacharia T, Goldenberg D, Goyal N (2015) Parathyroid localization using 4D-computed tomography. Ear Nose Throat J 94(4–5):E55–E57CrossRef
22.
go back to reference Beland MD, Mayo-Smith WW, Grand DJ, Machan JT, Monchik JM (2011) Dynamic MDCT for localization of occult parathyroid adenomas in 26 patients with primary hyperparathyroidism. AJR Am J Roentgenol 196(1):61–65CrossRef Beland MD, Mayo-Smith WW, Grand DJ, Machan JT, Monchik JM (2011) Dynamic MDCT for localization of occult parathyroid adenomas in 26 patients with primary hyperparathyroidism. AJR Am J Roentgenol 196(1):61–65CrossRef
23.
go back to reference Chazen JL, Gupta A, Dunning A, Phillips CD (2012) Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia. AJNR Am J Neuroradiol 33(3):429–433CrossRef Chazen JL, Gupta A, Dunning A, Phillips CD (2012) Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia. AJNR Am J Neuroradiol 33(3):429–433CrossRef
24.
go back to reference Gafton AR, Glastonbury CM, Eastwood JD, Hoang JK (2012) Parathyroid lesions: characterization with dual-phase arterial and venous enhanced CT of the neck. AJNR Am J Neuroradiol 33(5):949–952CrossRef Gafton AR, Glastonbury CM, Eastwood JD, Hoang JK (2012) Parathyroid lesions: characterization with dual-phase arterial and venous enhanced CT of the neck. AJNR Am J Neuroradiol 33(5):949–952CrossRef
25.
go back to reference Hoang JK, Sung WK, Bahl M, Phillips CD (2014) How to perform parathyroid 4D CT: tips and traps for technique and interpretation. Radiology. 270(1):15–24CrossRef Hoang JK, Sung WK, Bahl M, Phillips CD (2014) How to perform parathyroid 4D CT: tips and traps for technique and interpretation. Radiology. 270(1):15–24CrossRef
26.
go back to reference Bahl M, Muzaffar M, Vij G, Sosa JA, Choudhury KR, Hoang JK (2014) Prevalence of the polar vessel sign in parathyroid adenomas on the arterial phase of 4D CT. AJNR Am J Neuroradiol 35(3):578–581CrossRef Bahl M, Muzaffar M, Vij G, Sosa JA, Choudhury KR, Hoang JK (2014) Prevalence of the polar vessel sign in parathyroid adenomas on the arterial phase of 4D CT. AJNR Am J Neuroradiol 35(3):578–581CrossRef
27.
go back to reference Yeh R, Tay YD, Tabacco G, Coronel E, Dercle L (2018) Comparison of sestamibi SPECT/CT and parathyroid 4D CT with a 1-stop simultaneous imaging protocol. J Nucl Med 59:233 Yeh R, Tay YD, Tabacco G, Coronel E, Dercle L (2018) Comparison of sestamibi SPECT/CT and parathyroid 4D CT with a 1-stop simultaneous imaging protocol. J Nucl Med 59:233
28.
go back to reference Yeh R, Tay YD, Tabacco G et al (2019) Diagnostic performance of 4D CT and sestamibi SPECT/CT in localizing parathyroid adenomas in primary hyperparathyroidism. Radiology. 291(2):469–476CrossRef Yeh R, Tay YD, Tabacco G et al (2019) Diagnostic performance of 4D CT and sestamibi SPECT/CT in localizing parathyroid adenomas in primary hyperparathyroidism. Radiology. 291(2):469–476CrossRef
29.
go back to reference Fineman I, Johnson JP, Di-Patre PL, Sandhu H (1999) Chronic renal failure causing brown tumors and myelopathy. Case report and review of pathophysiology and treatment. J Neurosurg 90(2 Suppl):242–246PubMed Fineman I, Johnson JP, Di-Patre PL, Sandhu H (1999) Chronic renal failure causing brown tumors and myelopathy. Case report and review of pathophysiology and treatment. J Neurosurg 90(2 Suppl):242–246PubMed
30.
go back to reference Takeshita T, Tanaka H, Harasawa A, Kaminaga T, Imamura T, Furui S (2004) Brown tumor of the sphenoid sinus in a patient with secondary hyperparathyroidism: CT and MR imaging findings. Radiat Med 22(4):265–268PubMed Takeshita T, Tanaka H, Harasawa A, Kaminaga T, Imamura T, Furui S (2004) Brown tumor of the sphenoid sinus in a patient with secondary hyperparathyroidism: CT and MR imaging findings. Radiat Med 22(4):265–268PubMed
31.
go back to reference Sutbeyaz Y, Yoruk O, Bilen H, Gursan N (2009) Primary hyperparathyroidism presenting as a palatal and mandibular brown tumor. J Craniofac Surg 20(6):2101–2104CrossRef Sutbeyaz Y, Yoruk O, Bilen H, Gursan N (2009) Primary hyperparathyroidism presenting as a palatal and mandibular brown tumor. J Craniofac Surg 20(6):2101–2104CrossRef
32.
go back to reference Kar DK, Gupta SK, Agarwal A, Mishra SK (2001) Brown tumor of the palate and mandible in association with primary hyperparathyroidism. J Oral Maxillofac Surg 59(11):1352–1354CrossRef Kar DK, Gupta SK, Agarwal A, Mishra SK (2001) Brown tumor of the palate and mandible in association with primary hyperparathyroidism. J Oral Maxillofac Surg 59(11):1352–1354CrossRef
33.
go back to reference Rossi B, Ferraresi V, Appetecchia ML, Novello M, Zoccali C (2014) Giant cell tumor of bone in a patient with diagnosis of primary hyperparathyroidism: a challenge in differential diagnosis with brown tumor. Skeletal Radiol 43(5):693–697CrossRef Rossi B, Ferraresi V, Appetecchia ML, Novello M, Zoccali C (2014) Giant cell tumor of bone in a patient with diagnosis of primary hyperparathyroidism: a challenge in differential diagnosis with brown tumor. Skeletal Radiol 43(5):693–697CrossRef
34.
go back to reference Abdel Razek AA (2014) Computed tomography and magnetic resonance imaging of maxillofacial lesions in renal osteodystrophy. J Craniofac Surg. 25(4):1354–1357CrossRef Abdel Razek AA (2014) Computed tomography and magnetic resonance imaging of maxillofacial lesions in renal osteodystrophy. J Craniofac Surg. 25(4):1354–1357CrossRef
35.
go back to reference You M, Tang B, Wang ZJ, Wang KL, Wang H (2018) Radiological manifestations of renal osteodystrophy in the orofacial region: a case report and literature review. Oral Radiol 34(3):262–266CrossRef You M, Tang B, Wang ZJ, Wang KL, Wang H (2018) Radiological manifestations of renal osteodystrophy in the orofacial region: a case report and literature review. Oral Radiol 34(3):262–266CrossRef
Metadata
Title
Imaging of brown tumours: a pictorial review
Authors
Cheng Xie
Maria Tsakok
Nia Taylor
Karen Partington
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 1/2019
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1186/s13244-019-0757-z

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