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Pathological ankle fracture due to brown tumour: atypical presentation of low serum vitamin D with normal parathyroid hormone and bone profile
  1. Yizhe Lim1,
  2. Thomas Alfred Ball2 and
  3. Wen Wei Chin3
  1. 1Trauma and Orthopaedics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  2. 2Trauma and Orthopaedics, Torbay Hospital, Torquay, Torbay, UK
  3. 3Histopathology, University College Hospital, London, UK
  1. Correspondence to Dr Yizhe Lim; yizhelim{at}gmail.com

Abstract

Osteoclastomas or brown tumours are named as such due to increased vascularity, subsequent haemorrhage and haemosiderin deposition giving the lesion a reddish brown appearance under gross microscopic examination. It is due to an increase in parathyroid hormone activity from several causes, such as parathyroid adenomas, renal impairment and low vitamin D levels. The lesions increase the tendency of the bone to fracture. The challenging aspect of the diagnosis is that a histological diagnosis without immunohistochemistry is impossible to make. This is because, without special staining, brown tumours cannot be differentiated from giant cell tumours, which are also classed as benign but can be locally destructive and has potential for malignant transformation. Once tissue diagnosis is confirmed as a brown tumour, then aggressive forms of treatment are not needed, and they generally resolve once the underlying cause is treated. We describe a woman in her 80s who presented to the local Orthopaedic service with a pathological ankle fracture due to a brown tumour.

  • Orthopaedic and trauma surgery
  • Calcium and bone
  • Orthopaedics
  • Oncology

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Footnotes

  • Contributors TAB contributed to the conception and initial draft of the study. YL contributed to data collection, planning and writing of the manuscript. WWC contributed to the review of the histology slides and molecular testing. All authors have reviewed and agreed with the final manuscript for publishing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.