Brown tumor of the thoracic spine in a patient on long-term hemodialysis

A 39-year-old woman on long-term hemodialysis presented with a history of r apidly progressive paraplegia. Radiological examination showed a compressio n fracture of seventh thoracic vertebra and expansive mass lesion in the po sterior elements of the fourth thoracic vertebra. Laboratory tests on admis sion showed ser-um. calcium of 11.9 mg/dl, phosphate 6.0 mg/dl, and the hig h-sensitive parathyroid hormone level of 139,191 pg/ml measured by radioimm unoassay. Percutaneous biopsy of the expansive mass showed a large number o f multinucleated giant cells in a fibroblastic stroma containing abundant h emosiderin. Tumor resection and anterior interbody fusion with artificial b one graft was performed on 14th hospital day. Paraplegia gradually improved postoperatively. Total parathyroidectomy and autotransplantation of parath yroid gland were subsequently performed. Nodular hyperplasia was evident in the parathyroid glands by light microscopy. Brown tumor is rarely found in vertebral bone and this is the sixth case of such tumor in secondary hyper parathyroidism.