Multiple brown tumours in a renal transplantation patient with hyperparathyroidism.

A 30 year old woman presented to the Nephrology Department of University of Medicine Targu-Mures, Romania, with the complaint of gait changes of about four months. Her medical history included chronic glomerulonephritis, six months of haemodialysis, renal transplantation at the age of 19 and graft rejection. She received methylprednisolone (4 mg/day) for 11 years.

Serum parathyroid hormone level was 2639 pg/ml and that of alkaline phosphatase 2415 U/l. Plain radiography of the pelvis and chest showed multiple cystic lesions with osseous expansion (Figs 1, 2) suggestive for a brown tumour.

Fig. 1

Plain radiography of the pelvis with multiple expansile bone lytic lesions with distinct geographic margins (arrows A, B, C).

Fig. 2

Plain radiography of the chest. Multiple cystic lesions and grossly osseous expansion on the ribs (arrow numbers 2 and 5), clavicle (arrow number 3) and scapula (arrow number 1 and 4) with advanced cortical thinning.

Brown tumour is a form of “local” osteitis fibrosa cystica induced by hyperparathyroidism occurring in long bones, ribs, mandible and skull base12. These can mimic a giant cell tumour, myeloma or metastatic cancer. Multiple bone involvement are rare. Management needs the control of the hyperparathyroid state. Our patient did not accept parathyroidectomy. After 1 year of conservative treatment parathyroid hormone was 4989 pg/ml. Recently she underwent surgery for femoral neck fracture.