Case Report
Brown tumour of the spine in a renal transplant patient

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Abstract

We report a 30-year-old male who had undergone a renal transplant and suffered with secondary hyperparathyroidism. He presented with back pain and minimal neurological deterioration, caused by a thoracic brown tumour. The imaging findings, surgical treatment of the spinal lesion and outcome are discussed. We also discuss primary medical therapy and suggest a rational approach to further imaging of patients in whom brown tumour is suspected.

Section snippets

Case report

A 30-year-old male presented with back pain and unsteadiness of gait. The patient also described difficulty in micturition. He had previously undergone a renal transplant for end-stage renal failure secondary to a congenital structural abnormality and was known to suffer from secondary hyperparathyroidism.

On examination, his gait was broad based, but his power and proprioception were normal. His plantar responses were downgoing and his reflexes were normal, and his rectal examination revealed

Discussion

Although “brown tumour” suggests an aggressive lesion, it is a non-neoplastic process. Brown tumours are benign and represent localized accumulation of osteoclasts, fibrous tissue and blood; their high hemosiderin level gives them their characteristic brown colour.1

They occur as single or multiple lesions and can be found both within bone and in adjacent soft tissue. They commonly occur in the mandible, maxillary sinus, sternum, pelvis and femur. Brown tumours occur almost always exclusively in

Conclusion

Brown tumour is a rare complication of renal failure and secondary hyperparathyroidism. It should be considered where the clinical findings and imaging investigations support it as a likely diagnosis. Aggressive investigation to search for primary malignant lesions is not warranted. Primary treatment aimed at correcting biochemical abnormalities should be the first line of treatment. Surgery should be considered only if the primary treatment has failed or when there are impending or actual

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