Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4321-4326
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4321
Huge brown tumor of the rib in an unlocatable hyperparathyroidism patient with “self-recovered” serum calcium and parathyroid hormone: A case report
Wen-Da Wang, Ning Zhang, Qiang Qu, Xiao-Dong He
Wen-Da Wang, Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Ning Zhang, Qiang Qu, Xiao-Dong He, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: He XD, Zhang N and Wang WD performed the operation; Wang WD collected the case data and drafted the article; He XD and Qu Q made critical revisions to the manuscript.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: CARE Checklist (2016) statement has been uploaded.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Dong He, MD, Doctor, Professor, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Beijing 100730, China. hexiaodong@pumch.cn
Telephone: +86-10-69152613 Fax: +86-10-69152613
Received: August 17, 2019
Peer-review started: August 17, 2019
First decision: September 23, 2019
Revised: October 17, 2019
Accepted: November 15, 2019
Article in press: November 15, 2019
Published online: December 26, 2019
Abstract
BACKGROUND

The brown tumor is a kind of complication of hyperparathyroidism (HPT). The ultimate therapy usually is the resolution of HPT. We herein report an unlocatable HPT patient who received resection of a huge brown tumor of the rib, and experienced “self-recovery” of serum calcium and parathyroid hormone.

CASE SUMMARY

A 34-year-old female patient who suffered from a gradually increasing mass of the left chest wall since 2007 came to our hospital for treatment. The patient had a history of serum Ca and parathyroid hormone (PTH) increasing since June 2015 and received zoledronic acid treatment for 17 mo. When she came to our hospital in November 2017 after discontinuing medical treatment for 3 mo, the serum Ca and PTH levels were within normal ranges. The patient had no imaging abnormalities of parathyroid ultrasound or 99mTc-methoxyisobutyl isonitrile. Enhanced computed tomography revealed a local soft tissue mass of 96 mm × 113 mm with bone erosion of the left 8th rib, and the mass presented irregular enhancement with an unclear boundary between the mass and spleen. The mass was thought to likely be caused by HPT, but a malignancy could not be ruled out. Resection of the mass was performed, and the pathology proved that the mass was a brown tumor. A diagnosis of unlocatable HPT was considered. Since the serum Ca and PTH levels were both normal pre- and post-operation, the patient did not receive exploratory surgery for HPT, and received regular follow-up.

CONCLUSION

The huge brown tumor of the rib and “self-recovered” serum PTH and Ca levels are relatively rare in HPT patients. An exploratory operation may be deferred for these patients, and long-term follow-up should be performed.

Keywords: Brown tumor, Hyperparathyroidism, Unlocatable, Self-recovered, Resection, Case report

Core tip: This is a very interesting case of unlocatable hyperparathyroidism (HPT). The patient presented a huge mass on her left chest wall. However, the serum Ca and parathyroid hormone levels were both normal pre- and post-operation, and the diagnosis was difficult to make. The mass was thought to be likely caused by HPT, but a malignancy could not be ruled out. Finally, the pathology proved that the mass was a brown tumor. Since the patient experienced serum calcium and parathyroid hormone “self-recovery”, she did not receive exploratory surgery for HPT, and received regular follow-up.