Abstract
Introduction: Brown tumours occur as a complication in patients with renal failure, due to secondary hyperparathyrodism. In these patients brown tumours commonly regress if the primary cause is treated. We present a rare case of recalcitrant brown tumour with unusual presentation and symptom complex requiring surgical intervention.
Case Report: 14-year-old girl with blindness presented with pain in the proximal tibia. Radiographs revealed a lytic lesion in the proximal tibia. Biopsy of the lesion showed osteoclast rich stroma. Blood investigations indicated renal impairment, and secondary hyperparathyroidism. She underwent repeated dialysis treatment, and her renal parameters and parathormone levels were brought back to within normal limits. However, there was no evidence of regression of the lesion. Hence, intralesional curettage of the brown tumour was performed while still maintaining her on regular dialysis. This resulted in complete healing of the brown tumour with no recurrence at latest follow-up. She recently had a renal transplant as a definitive treatment for her renal failure.
Conclusion: The patient in our case has got renal retinal dysplasia which resulted in juvenile renal failure and retinal pigmentary degeneration. The renal failure resulted in secondary hyperparathyroidism leading to the formation of bone tumour in the proximal tibia. Eventhough temporarily the renal parameters were restored to within normal limits, this tumour did not regress in size, and hence required surgical intervention. This case highlights the importance of detailed thorough investigations to find the primary cause and syndrome associated with juvenile renal failure which presented with only a bony abnormality.
The abstracts were prepared by Mrs Leslie O’Leary. Correspondence should be addressed to her at British Orthopaedic Association, 35–43 Lincoln’s Inn Fields, London WC2A 3PE or at l.oleary@boa.ac.uk
