{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T01:52:53Z","timestamp":1785462773422,"version":"3.56.0"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T00:00:00Z","timestamp":1724716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction and importance:<\/jats:title>\n                    <jats:p>Brown tumors are non-neoplastic reactive tissue with osteoclasts multinucleated giant cells, and vascular and proliferative fibrous tissue. Hemorrhage results in significant bone resorption caused by hyperparathyroidism. This study provides information about the diagnosis challenge for brown tumor cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case description:<\/jats:title>\n                    <jats:p>\n                      We report four cases that experience pathological fractures with moderate pain, multiple lytic lesions, severe hypercalcemia, increased ALP (Alkaline Phosphatase), and PTH (Parathyroid Hormone). Abnormal parathyroid mass was found in ultrasound. A bone scan described increasing radio uptake in various bones, a whole body scan, or\n                      <jats:italic toggle=\"yes\">parathyroid scintigraphy<\/jats:italic>\n                      with\n                      <jats:sup>99m<\/jats:sup>\n                      Tc-\n                      <jats:italic toggle=\"yes\">MIBI<\/jats:italic>\n                      . Eventually, in all cases, the diagnosis of the brown tumor was confirmed through histopathological examination, which showed multiple nucleated giant cells with a deposit of hemosiderin pathognomonic for the brown tumor, and the diagnosis of primary hyperparathyroidism (PHPT) was confirmed in all cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical discussion:<\/jats:title>\n                    <jats:p>These cases show that initial misdiagnosis of brown tumors as other bone tumors. A definitive diagnosis of brown tumors requires more than just histological confirmation. A comprehensive evaluation encompassing laboratory tests, imaging studies, clinical symptoms, and a multidisciplinary orthopedic-oncology board discussion is essential. Observations show that treating hyperparathyroidism alleviates the osteolytic lesions caused by brown tumors, despite the lack of clinical guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Based on a review of the literature and our clinical experience, we recommend screening serum calcium, phosphorus, and PTH levels in patients presenting with multiple lesions and widespread bone pain. This screening aims to rule out multiple bone lesions caused by PHPT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2024.110221","type":"journal-article","created":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T12:49:07Z","timestamp":1724849347000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic challenge of the brown tumors in developing country: A case series"],"prefix":"10.1097","volume":"123","author":[{"given":"Erny","family":"Khomariyah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunita","family":"Purnamasari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Hardian","family":"Basuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stepanus","family":"Massora","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-52-20260507","article-title":"Brown tumor of the iliac crest initially misdiagnosed as a giant cell tumor of the bone","volume":"2020","author":"Hamidi,","year":"2020","journal-title":"Endocrinol Diabetes Metab Case Rep"},{"key":"R2-52-20260507","article-title":"Brown tumors of hyperparathyroidism misdiagnosed as multifocal giant cell tumors of bone: a case report","volume":"21","author":"Kamal,","year":"2020","journal-title":"Human Pathology: Case 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Disord"},{"key":"R6-52-20260507","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2023.1088984","article-title":"Refractory hypercalcemia of malignancy: a problem with many potential roots","volume":"14","author":"Farooki,","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"2","key":"R7-52-20260507","doi-asserted-by":"crossref","first-page":"417","DOI":"10.3171\/jns.2003.98.2.0417","article-title":"Brown tumors of the skull base","volume":"98","author":"Al-Gahtany,","year":"2003","journal-title":"J Neurosurg"},{"issue":"11","key":"R8-52-20260507","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1002\/hed.20905","article-title":"Evolution of maxillofacial brown tumors after parathyroidectomy in primary hyperparathyroidism","volume":"30","author":"Res\u00e9ndiz-Colosia,","year":"2008","journal-title":"Head Neck"},{"issue":"4","key":"R9-52-20260507","doi-asserted-by":"crossref","first-page":"614","DOI":"10.3803\/EnM.2015.30.4.614","article-title":"Primary hyperparathyroidism with extensive brown tumors and multiple fractures in a 20-year-old woman","volume":"30","author":"Choi,","year":"2015","journal-title":"Endocrinol Metab"},{"issue":"1","key":"R10-52-20260507","first-page":"54","article-title":"Ossification of the cervical ligamentum flavum and osseous brown tumor: late manifestations of primary hyperparathyroidism misdiagnosed in a case of parathyroid carcinoma","volume":"13","author":"Sampanis,","year":"2016","journal-title":"Clin Cases Miner Bone Metab"},{"issue":"14","key":"R11-52-20260507","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000015007","article-title":"Management of brown tumor of spine with primary hyperparathyroidism","volume":"98","author":"Hu,","year":"2019","journal-title":"Medicine"},{"issue":"8","key":"R12-52-20260507","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1097\/MNM.0b013e328347b582","article-title":"Clinical implications of brown tumor uptake in whole-body 99mTc-sestamibi scans for 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