Keywords
atypical adenoma
brown tumors
lytic bone lesions
hypercalcemia
parathyroid surgery
clinical follow-up
How to Cite
Abstract
Background: Atypical parathyroid adenoma (APA) is a rare neoplasm with features between benign adenoma and carcinoma. It often presents with severe hypercalcemia and lytic bone lesions such as brown tumors, which may mimic metastatic disease, complicating the diagnosis.
Purpose: To describe a case of giant APA with multiple brown tumors mimicking bone metastases, highlighting clinical, biochemical, imaging, and histopathological findings, as well as treatment and follow-up.
Case presentation: A 33-year-old woman presented with chronic bone pain, progressive muscle weakness, and significant weight loss. On examination, she had a mandibular mass and a left cervical nodule. Labs showed hypercalcemia (14.16 mg/dL), elevated PTH (725 pg/mL), and high alkaline phosphatase (1183 U/L). Imaging revealed multiple lytic lesions suggestive of brown tumors. A SESTAMIBI scan localized a left parathyroid adenoma. She underwent parathyroidectomy, and histopathology confirmed APA. Postoperatively, PTH and calcium levels normalized. At two-year follow-up, the patient showed sustained clinical and radiologic improvement.
Discussion and conclusion: APA is a diagnosis of exclusion and requires histological and immunohistochemical evaluation to differentiate it from malignancy. Although its presentation can be misleading, timely surgical intervention usually results in favorable outcomes. Long-term follow-up is essential to monitor recurrence. This case highlights the importance of considering endocrine causes like APA in patients with aggressive bone lesions. A multidisciplinary approach with early diagnosis and surgery can significantly improve prognosis and reduce complications.
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