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Presented by Edward McCarthy, M.D. and prepared by Lynette S. Nichols, M.D.
Case 4: A 10 year old boy with chronic renal disease had a history of pain in his fourth MP joint of his right hand for several months.
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1. Question
Week 108: Case 4
A 10 year old boy with chronic renal disease had a history of pain in his fourth MP joint of his right hand for several months. A radiograph demonstrated a lytic lesion in the metaphyseal area of the proximal phalanx as well as a small lytic lesion in the metaphysis of the metacarpal.images/mccimages/Mcc93002-6-a.jpg
images/mccimages/Mcc93002-6-b.jpg
images/mccimages/Mcc93002-6-c.jpg
images/mccimages/Mcc93002-6-d.jpgCorrect
Answer: Brown tumor of hyperparathyroidism (giant cell reparative granuloma)
Histology: This lesion, which contains many of giant cells, shows a distinct zonal pattern which is characteristic of a giant cell reparative granuloma. The giant cells are in clusters surrounded by blood cells and bounded by fibrous tissue and further bounded by reactive bone.
Discussion: This zonal pattern is typical of a giant cell reparative granuloma. In a setting in which a patient has renal failure and secondary hyperparathyroidism, this lesion is a manifestation of a brown tumor secondary to the hyperparathyroidism that accompanies renal failure.
The lesion is not a giant cell tumor because of the zonal pattern. Moreover, the metaphyseal location and the multifocality do not support a diagnosis of giant cell tumor.
Although an enchondroma is the most common tumor in the hand, there is no cartilage in this lesion.
There is no atypia or mitotic activity which would support a diagnosis of malignant fibrous histiocytoma.
Incorrect
Answer: Brown tumor of hyperparathyroidism (giant cell reparative granuloma)
Histology: This lesion, which contains many of giant cells, shows a distinct zonal pattern which is characteristic of a giant cell reparative granuloma. The giant cells are in clusters surrounded by blood cells and bounded by fibrous tissue and further bounded by reactive bone.
Discussion: This zonal pattern is typical of a giant cell reparative granuloma. In a setting in which a patient has renal failure and secondary hyperparathyroidism, this lesion is a manifestation of a brown tumor secondary to the hyperparathyroidism that accompanies renal failure.
The lesion is not a giant cell tumor because of the zonal pattern. Moreover, the metaphyseal location and the multifocality do not support a diagnosis of giant cell tumor.
Although an enchondroma is the most common tumor in the hand, there is no cartilage in this lesion.
There is no atypia or mitotic activity which would support a diagnosis of malignant fibrous histiocytoma.
