A rare case of cauda equina syndrome from a brown tumour
- PDF / 621,917 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 75 Downloads / 166 Views
CASE REPORT
A rare case of cauda equina syndrome from a brown tumour Tahira Christine Scott1,2 · Grahame Elder3,4 · Vikas Srivastava5 Received: 9 April 2020 / Accepted: 26 May 2020 © Italian Society of Nephrology 2020
Clinical case A fifty-one-year-old indigenous Australian male with End Stage Kidney Disease (ESKD) from hypertension, on thrice weekly haemodialysis for the past two years, presented to hospital with lower back pain. The Patient had untreated secondary hyperparathyroidism related to his kidney disease because of poor adherence to medications and refusal of parathyroidectomy. Computed tomography of the lumber spine showed multiple lytic lesions concerning for metastatic deposits. No primary malignancy was identified after further imaging studies. Biochemical parameters included a normal lactate dehydrogenase of 140 U/L (120–250), parathyroid hormone (PTH) level of 178 pmol/L (1–7), alkaline phosphatase (ALP) of 398 U/L (30–110), phosphate of 2.27 mmol/L (0.75–1.5) and corrected calcium of 2.23 mmol/L (2.10–2.6). Percutaneous biopsy of the L3 vertebral lesion by interventional radiology was promptly organised. Histology revealed sheets of fibroblasts and numerous multinucleated giant cells with hemosiderin deposition suggestive of a brown tumour (Fig. 1). Two weeks after the biopsy the patient developed saddle paraesthesia concerning for cauda equina syndrome. Urgent non-contrast magnetic resonance imaging demonstrated a large compressive mass extending from S1 to S3 and obliterating the sacral canal and cauda equina (Fig. 2). After * Tahira Christine Scott [email protected] 1
Department of Renal Medicine, The Princess Alexandra Hospital, Brisbane, Australia
2
University of Queensland, Brisbane, Australia
3
Department of Renal Medicine, Westmead Hospital, University of Sydney, Sydney, Australia
4
Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research Sydney, Sydney, Australia
5
Department of Renal Medicine, Townsville University Hospital, Townsville, Australia
neurosurgical consultation the patient underwent immediate lumber decompressive laminectomy and removal of the spinal extradural tumour. A parathyroidectomy was expedited to prevent further brown tumour deposition, induce tumour regression of other spinal lesions and improve bone pain.
Lessons for nephrologists This rare case of cauda equina syndrome from a brown tumour should remind nephrologists that brown tumours, although now infrequent, can still occur in the dialysis cohort and must not be overlooked.
What are brown tumours and what symptoms can they cause? Brown tumours also known as osteitis fibrosa cystica, are benign lytic bone tumours that generally occur in the setting of untreated secondary hyperparathyroidism. Histologically they are characterised by excess osteoclast multinucleated giant cell activity within fibrous tissue, woven bone and hemosiderin deposition due to vascular haemorrhage (hence the term ‘brown’) [1]. Due to rapid osteolysis these lesions may be locally dest
Data Loading...
