Abstract: FR-PO635
Lytic Lesions in A Dialysis Patient: It’s Not Always Cancer
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Epstein, David L., The Rogosin Institute, New York, New York, United States
- Agaram, Narasimhan P., Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Barker, Juliet N., Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Jaffer Sathick, Insara, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction
Secondary hyperparathyroidism is a known complicaiton of end stage renal disease (ESRD). Increased production of parathyroid hormone (PTH) leads to excess osteoclast activity and fibroblast proliferation. In severe cases, patients are at risk of developing bone lesions called brown tumors.
Case Description
A 31 year old female with history of Hodgkins lymphoma treated with umbilical cord transplant and ESRD due to hypertension on dialysis for six years, presented for kidney transplant evaluation. She had no systemic complaints and an unremarkable physical exam. Laboratory values were significant for elevated PTH 1874 pg/ml. As part of her transplant evaluation, she underwent CT scan showing multiple bony lesions concerning for malignancy. PET scan confirmed FDG avid lytic lesions (Figure 1a). Biopsy of the right iliac crest (Figure 1b) revealed a giant cell rich lesion with osteoclasts and hemosiderin pigment deposition. Despite being medically managed with cinacalcet and doxercalciferol, the patient developed diffuse lytic bone lesions consistent with brown tumor of hyperparathyroidism.
Discussion
Brown tumor is a rare finding in ESRD patients and has an estimated incidence of 1.7 %. Clinically, they can be silent unless there is compression of surrounding structures. CT or PET imaging reveals the lesions, but histopathology is necessary to identify the giant cell granulomas with brown colored hemosiderin deposits from which the tumor gets its name from. Treatment begins with pharmacologic therapy to lower PTH, but can be ineffective, and parathyroidectomy and evaluation for kidney transplantation should be considered. This case underlines the importance of recognizing Brown tumor as a complication and important differential diagnosis of a patient with imaging showing lytic lesions. Prevention and early diagnosis are essential to reduce the prevalence of high turnover bone disease.
Figure 1