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December 2013

Clinical Challenge of the Year

JAMA Surg. 2013;148(12):1153. doi:10.1001/jamasurg.2013.4814

Congratulations to Theresia Weber, MD, Alexandra von Baer, MD, Markus Schultheiß, MD, Clemens Maier-Funk, MD, Markus Luster, MD, Thomas F. E. Barth, MD, and Bernhard O. Boehm, MD, of University Hospital in Ulm, Germany. They coauthored the winning Clinical Challenge of the Year for 2013. Their Clinical Challenge article on cystic lesions with suspected soft tissue infiltration appeared in the July 2013 issue (JAMA Surg. 2013;148[7]:691-692). This Clinical Challenge began with dramatic magnetic resonance images of cystic lesions in a young patient’s lower extremity with suspected soft tissue infiltration. The findings in these images seemed to point towards a diagnosis of a malignant bone tumor of the leg. However, a positron emission tomography/computed tomography scan showed a parathyroid adenoma in the neck and workup confirmed hyperparathyroidism as the cause of the bony lesions. The discussion summarized the so-called brown tumors of hyperparathyroidism and introduced “an autosomal dominant [hyperparathyroidism]–jaw tumor syndrome,” which the patient also seemed to illustrate. As noted by the authors, the incidence of brown tumors in Europe and the United States has become very low, so these unusually advanced manifestations of hyperparathyroidism make their illustration particularly useful. In addition to excellent images, much information was conveyed in this succinct and clearly written article.