Spinal brown tumors as a rare cause of spinal cord compression: Report of case series

Brown tumors (BTs) are rare benign osteolytic lesions that arise in the context of uncontrolled hyperparathyroidism. They mostly located in the large bone and rarely in the spine. Spine involvement can cause neurologic symptoms and rarely spinal cord compression. The aim of this study is to diagnose BTs of the spine in presence of spinal cord compression symptoms leading to appropriate treatment.

Retrospective study of 4 cases of Brown tumors revealed by spine cord compression and rapidly operated in our neurosurgery department between 2014 and 2024. The demographic, clinical radiological, surgical, histopathological and outcome characteristics are collected for each patient.

We collected data from four patients over a period of eleven years. They are 2 males and 2 females with mean age of 46 years. One patient diagnosed as a primary hyperparathyroidism and three on end stage renal failure diagnosed as secondary hyperparathyroidism. Patients presented with spinal cord compression syndrome with varying degrees of neurological impairment, including paraparesis, sensory deficits, and sphincter disturbances. Imaging revealed osteolytic lesions with spinal cord compression in two cervical, one thoracic and a one lumbar case. Laboratory findings showed elevated parathyroid hormone (PTH) and alkaline phosphatase levels. Surgical intervention, with urgent decompression, was performed in all cases, resulting in neurological improvement. Histological study of these lesions confirmed the diagnosis of Brown tumors by the presence of bone resorption, clusters of multinucleated giant cells, spindled mononuclear cells, vascularized stroma, hemorrhage, and hemosiderin deposition.

This case series highlights the importance of considering brown tumors in the differential diagnosis of spinal compressive lesions, particularly in patients with endocrine and metabolic disorders. To our knowledge, this is the second case-series reported of spinal brown tumors.