Diagnostic challenge in childs bone cystic lesions
Marioara Cornianu1,2, Ioana Micle1,3, Ioana Golu1,4, Mihaela Vlad1,4, Alis Dema1,2, Sorina Taban1,2, Anca Muresan1,2 & Codruta Lazureanu1,2
Introduction: Primary hyperparathyroidism (PHP) affects predominantly the adult age (incidence 1/10 000) and it is unusual.
The aim of the study: Is to present a rare pathology in a child, which implied interdisciplinary collaboration.
Material and method: We present a teenager girl of 16 years old, diagnosed with osteomalacia after a thoracic and pelvis trauma, based on knee and pelvis radiographs (diffuse bone demineralization, trabecular rarefaction). The persistence and increasing bone pelvic pain, imposed a complete evaluation (multiple admissions in Pediatric Clinic no. I, Timisoara), with phosphocalcic metabolism (total serum calcium 3.19 mmol/l, alkaline phosphatase 1639 U/l), MRI (multiple cystic lesions in pelvic bones, bilateral femoral diaphyses and patellae) and bone biopsy, which established the diagnosis of osteoclastoma.
Multiple osteolysis foci (right humerus), along with serum calcitonin levels (6.5 pg/ml) and excessive parathormone secretion (PTH 1428 pg/ml) established the diagnosis of PHP and von Recklinghausen fibrocystic osteitis.
Cervical imagistic explorations (ultrasonography, MRI) revealed a solid nodule of 3.2/1.7/1.6 cm, clearly delimitated, located on the posterior side of the right thyroid lobe and multiple cystic lesions, in the sternum, ribs and right scapula, raising the suspicion of a parathyroid adenoma.
Results: The diagnosis of parathyroid adenoma was confirmed by right superior parathyroidectomy (performed in Surgical Clinic, County Hospital Timisoara). After surgery, the substitution therapy was commenced and bone lesions presented a favourable evolution.
Conclusion: The peculiarity of this case is based on the young age of the patient, the diagnosis made in fibrocystic osteitis stage, and the differentiation of the osteoclastoma from hyperparathyroid brown tumor based on phosphocalcic metabolism results.