Unusual spinal manifestation in secondary hyperparathyroidism - A case report

Study Design. Case report. Objectives. To describe an unusual spinal manifestation of secondary hyperparathyroidism in a 29-year-old woman and discuss the pathologic basis of the disease and evaluate the response to treatment. Summary of Background Data. Extraskeletal tumoral calcification (i.e., tumoral calcinosis, tumoral calcinosis-like lesion, calcifying pseudoneoplasms) is an uncommon entity associated with secondary hyperparathyroidism. Involvement of the cervical spine with this tumor causing neural compression is extremely rare. Only a few cases have been reported in literature and none with a concomitant presence of brown tumors. Methods. A 29-year-old woman presented with upper back pain with tingling and weakness in the left hand. She had been on dialysis for 5 years following renal failure. She had a partial parathyroidectomy for hyperparathyroidism a year ago. Para vertebral calcification eroding the posterior elements of C6-T2 and abutting the dura and neural foramens was seen on a CT scan. There were numerous lytic defects of the thoracic and lumbar vertebral bodies, most notable at L4, suggesting focal brown tumors. An MRI scan of the spine demonstrated a large heterogeneously hypointense lesion of the cervicothoracic spine, which remained hypointense on T2 images. A cervicothoracic decompression and spinal stabilization from the front and back was performed. A pathologic diagnosis of tumoral calcinosis-like lesion was confirmed. Result. Following surgery, the patient recovered neurologically and subsequently underwent total parathyroidectomy. Presently, her bone lesions have healed. Conclusion. Hyperparathyroidism may cause tumoral calcinosis-like lesions in the spine. An early spinal decompression followed with parathyroidectomy leads to remission of symptoms.