Brown tumor in the cricoid cartilage: a rare laryngeal manifestation of hyperparathyroidism - case report

Abstract Background Brown tumors are rare, benign bone lesions associated with hyperparathyroidism, typically involving long bones and the mandible. Laryngeal involvement is exceedingly rare. Case presentation We report a rare case of a brown tumor involving the cricoid cartilage, in order to describe its clinical presentation and management. A 40-year-old male with a history of nephrectomy, hypertension and chronic hemodialysis for end-stage renal disease was under regular follow-up for secondary hyperparathyroidism. He presented with a history of progressive dyspnea and dysphonia. On physical examination, the patient showed signs of respiratory distress, including bradypnea, stridor and suprasternal retraction. Biological investigations revealed a markedly elevated serum parathyroid hormone level, consistent with secondary hyperparathyroidism. Computed tomography scan showed multiple osteolytic lesions including a tumoral mass in the cricoid cartilage, which narrowed the proximal tracheal lumen by approximately 80%. Surgical management included a subtotal parathyroidectomy 7/8, a right loboisthmectomy, biopsy of the cricoid cartilage, and tracheotomy to secure the airway. The histological examination confirmed diffuse parathyroid hyperplasia in all four glands, a non-nodular right lobe and a brown tumor of the cricoid cartilage. Postoperative outcomes were favorable with normalization of sPTH and no recurrence or persistence of HPTH at 2-year follow-up. Conclusion Brown tumor involvement of the laryngeal skeleton is extremely uncommon. Early recognition and appropriate surgical management are crucial to prevent life-threatening complications.