Brown tumors

Brown tumours

of the hands in a patient with hyperparathyroidism. This is an edited version of the source image made for use in the "Anatomist" iOS and Android app and shared here under the terms of the source image"s Share Alike Creative Commons license.

Wikipedia • CC BY-SA 4.0

Lost bones:

differential diagnosis of acro-osteolysis seen by the pediatric rheumatologist. Frontal radiograph of the left hand in a 14 year old male patient with hyperparathyroidism demonstrates acro-osteolysis (arrowheads), subperiosteal resorption at the middle phalanges (small arrows), brown tumors (large arrows) and diffuse osteopenia

ped-rheum.biomedcentral.com • CC-by-4.0

Brown tumor

• Brown tumor - Ganzer Fall bei Radiopaedia

Salam, H. Brown tumor. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-12460 • CC by-nc-sa 3.0 (modified)

Brown tumors

in chronic renal failure. Axial reconstruction unenhanced CT images showing sclerotic lesions in the same sites, T9 and L1, after normalization of PTH levels (red arrows).

www.eurorad.org • CC by-nc-sa-4.0

Brown tumor

• Brown tumor - Ganzer Fall bei Radiopaedia

Salam, H. Brown tumor. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-12318 • CC by-nc-sa 3.0 (modified)

Brown tumor

• Renal osteodystrophy - Ganzer Fall bei Radiopaedia

Ibrahim, D. Renal osteodystrophy. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-58863 • CC by-nc-sa 3.0 (modified)

Brown tumor

• Primary hyperparathyroidism with brown tumor - Ganzer Fall bei Radiopaedia

Skalski, M. Primary hyperparathyroidism with brown tumor. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-29475 • CC by-nc-sa 3.0 (modified)

Brown tumor

• Brown tumor with secondary hyperparathyroidism - Ganzer Fall bei Radiopaedia

Deepak, A. Brown tumor with secondary hyperparathyroidism. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-23591 • CC by-nc-sa 3.0 (modified)

Brown tumor

• Brown tumor - skull - Ganzer Fall bei Radiopaedia

Niknejad, M. Brown tumor - skull. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-20669 • CC by-nc-sa 3.0 (modified)

Brown tumor

• Brown tumors - Ganzer Fall bei Radiopaedia

Niknejad, M. Brown tumors. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-20607 • CC by-nc-sa 3.0 (modified)

Brown tumor

• Brown tumor - Ganzer Fall bei Radiopaedia

Radswiki, T. Brown tumor. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-11263 • CC by-nc-sa 3.0 (modified)

Brown tumor

• Brown tumor - Ganzer Fall bei Radiopaedia

Radswiki, T. Brown tumor. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-11264 • CC by-nc-sa 3.0 (modified)

Brown tumor

• Brown tumor - Ganzer Fall bei Radiopaedia

Salam, H. Brown tumor. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-12318 • CC by-nc-sa 3.0 (modified)

Renal

osteodystrophy: AP view of the pelvis (a) in a 26-year-old female with secondary hyperparathyroidism that results in multiple, circumscribed, and expanded lucent areas compatible with brown tumors. Associated fracture deformity of the right femoral head and generalized demineralization.

Wikipedia • CC BY 3.0

Brown tumours

(ECR 2016 Case of the Day). Choline PET/CT, axial sections of the pelvis A. CT window B. fusion window.

www.eurorad.org • CC by-nc-sa-4.0

Brown tumours

(ECR 2016 Case of the Day). MRI of the lower limb, axial sections; A. T1-weighted image, B. T1-weighted post-contrast image.

www.eurorad.org • CC by-nc-sa-4.0

Brown tumours

(ECR 2016 Case of the Day). MRI of the lower limb, coronal sections A. T2-weighted fat-saturated image; B. T1-weighted fat-saturated post contrast image.

www.eurorad.org • CC by-nc-sa-4.0

Brown tumours

(ECR 2016 Case of the Day). CT, axial sections; A and B the lower limb, C and D the lower jaw.

www.eurorad.org • CC by-nc-sa-4.0

Brown tumours

(ECR 2016 Case of the Day). Radiograph of the lower limb, AP and lateral.

www.eurorad.org • CC by-nc-sa-4.0

Brown tumours

(ECR 2016 Case of the Day). Radiograph of the hand, PA

www.eurorad.org • CC by-nc-sa-4.0

Brown tumor

• Brown tumors compressing the spinal cord - Ganzer Fall bei Radiopaedia

Glick, Y. Brown tumors compressing the spinal cord. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-68442 • CC by-nc-sa 3.0 (modified)

Brown tumor

• Facial bone brown tumors - primary hyperparathyroidism - Ganzer Fall bei Radiopaedia

Khedr D, Facial bone brown tumors - primary hyperparathyroidism. Case study, Radiopaedia.org (Accessed on 19 May 2023) https://doi.org/10.53347/rID-156445 • CC by-nc-sa 3.0 (modified)

Brown tumors

in chronic renal failure. Axial reconstruction unenhanced CT images showing lytic lesions in T9 and L1 vertebral bodies (red arrows).

www.eurorad.org • CC by-nc-sa-4.0

Brown tumors

in chronic renal failure. Axial reconstruction unenhanced CT showing a well defined lytic lesions in left iliac bone (red arrows).

www.eurorad.org • CC by-nc-sa-4.0

Brown tumors

in chronic renal failure. Coronal reconstruction unenhanced CT showing a well defined lytic lesion in right iliac bone (red arrow).

www.eurorad.org • CC by-nc-sa-4.0

Brown tumor

• Brown tumor - Ganzer Fall bei Radiopaedia

Anan R, Brown tumor. Case study, Radiopaedia.org (Accessed on 02 Dec 2023) https://doi.org/10.53347/rID-171650 • CC by-nc-sa 3.0 (modified)

Osteitis

fibrosa cystica of the tibia

Wikipedia • GFDL

Imaging of

skull vault tumors in adults. Miscellany. Paget disease (a, b) CT (a) and X-ray (b): Characteristic mixed bone lysis and sclerosis, cortical bone thickening, and expansion. Osteoporosis circumscripta cranii CT (c, d): large geographic radiolucent areas involving medullar and cortical bone in frontal and occipital regions (arrows). Amyloidoma (e, f) CT (e) and T2WI (f): Giant heterogeneous mass with marked T2 hypointensity and calcifications. Renal osteodystrophy CT (g): shows characteristic “salt-and-pepper pattern.” Brown tumor (h, i): unspecific well-defined, cystic appearance (arrows). Thalassemia CT (j): Diffuse diploic widening and “hair-on-end” appearance (arrow) with characteristic occipital bone preservation (arrowhead). Bone sarcoidosis (k, l) CT (k) and T2WI (l): Mixed predominantly lytic multiple lesions with lace-like internal pattern of calcification and T2 hypointensity (dashed arrows). Osteitis CT (m, n): Bone focal lysis and erosions of osteitis (arrows) contiguous to a frontal sinusitis complicated with intracranial laminar abscess (dashed arrow)

insightsimaging.springeropen.com • CC-by-4.0

Radiopaedia • CC-by-nc-sa 3.0 • de

Brown tumor, also known as osteitis fibrosa cystica and rarely as osteoclastoma, is one of the manifestations of hyperparathyroidism. It represents a reparative cellular process, rather than a neoplastic process. Histologically brown tumors are identical to giant cell tumor (both are osteoclastomas), and therefore, this entity can easily be misdiagnosed as such if elevated blood calcium and/or parathyroid hormone levels are not assessed for and identified.

Epidemiology

Brown tumors have a slightly greater frequency in primary than in secondary hyperparathyroidism (3% versus 2%). However, secondary hyperparathyroidism is much more common than primary hyperparathyroidism, therefore most brown tumors that are seen are associated with secondary hyperparathyroidism.

Pathology

In chronic renal disease, continual and excessive urinary calcium excretion can lower serum calcium level and lead to a rise in parathyroid hormone secretion. This results in mobilization of skeletal calcium through rapid osteoclastic turnover of bone to maintain normal serum calcium levels.

In localized regions where bone loss is particularly rapid, hemorrhage, and reparative granulation tissue, with active, vascular, proliferating fibrous tissue may replace the normal marrow contents, resulting in a brown tumor.

Hemosiderin imparts the brown color (hence the name of the lesions).

Radiographic features

Plain radiograph

Well-defined, purely lytic lesions that provoke little reactive bone. The cortex may be thinned and expanded, but will not be penetrated.

CT

Attenuation values on CT will be in the range of blood and fibrous tissue.

Angiography (DSA)

lesions are usually hypervascular

MRI

The MRI appearance depends on the relative proportion of its components. The lesions, therefore, may be solid, cystic, or mixed. Solid components are intermediate to low intensity on T1- and T2-weighted images, while the cystic components are hyperintense on T2-weighted images and may have fluid-fluid levels.