Multiple Brown Tumors With Tc-99m MDP Superscan Appearance and Negative Tc-99m MIBI Uptake

Abstract

A 20-year-old man presented with a spontaneous left humerus fracture after minimal loading. X-rays and a CT scan revealed multiple lytic lesions throughout the skeleton (humeri, ribs, spine, pelvic bones, femorals). Blood chemistries showed severe hypercalcemia of 15.7 mg/dL and hypophosphatemia, whereas the biopsy of a lytic lesion (right humerus) showed only a few macrophages and multinuclear giant cells. Tc-99m MDP and Tc-99m MIBI scans were performed. Neck surgery verified the presence of a parathyroid adenoma. The multiple lytic lesions that were seen are brown tumors (osteoclastomas) without focal Tc-99m MDP or Tc-99m MIBI uptake.