scholarly journals SAT-364 Brown Tumor of the Mandible in Severe Uncontrolled Primary Hyperparathyroidism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Suruchi K Gupta ◽  
Runhua Hou ◽  
Harold Rosen
Keyword(s):  
Primary Hyperparathyroidism ◽  
Ct Scan ◽  
The United States ◽  
Osteitis Fibrosa ◽  
Brown Tumor ◽  
Osteitis Fibrosa Cystica ◽  
Hypercalcemia Of Malignancy ◽  
Brown Tumors ◽  
The Right ◽  
Pth Level

Abstract Background: Brown tumors are a part of the complex “osteitis fibrosa cystica” which is a diffuse resorptive process of the bone resulting from uncontrolled hyperparathyroidism. Although these brown tumors were fairly common in the past1, the incidence of brown tumors is now extremely rare in the United States due to early diagnosis and treatment of hyperparathyroidism. Here we describe an unusual presentation for osteitis fibrosa cystica. Clinical Case: A 38 year old woman was admitted to the hospital with rapidly growing facial swelling in June 2019. The swelling initially appeared in January 2019 and had rapidly increased in size since April 2019. The mass was malodorous, painful and interfered with oral intake. The patient smoked 1 pack per day for 13 years. A CT scan of the head and neck with contrast showed a 3.6 x 4.5 x 3.3 cm mass destroying the right mandibular body, involving the right platysma muscle and displacing the central and lateral incisor teeth and was concerning for malignancy. The initial impression was that this was likely a squamous cell carcinoma with local and perhaps distant metastases, complicated by humoral hypercalcemia of malignancy and she was admitted for management. Upon admission, her calcium level was 14 mg/dL, albumin 4.1 g/dL, phosphorus 1.4 mg/dL PTH level was 890 pg/mL and vitamin D level was 22 ng/mL. Since the high PTH did not fit with hypercalcemia of malignancy, further evaluation was undertaken. A thyroid ultrasound showed a 4.6 x 1.8 x 1.5 cm isoechoic, heterogeneous lesion in the left lower pole, and Tc-99 sestamibi scan suggested parathyroid origin. The biopsy of the mouth lesion showed fibro histiocytic proliferation with multiple giant cells, negative for malignancy and consistent with a brown tumor. CT scan of the chest, abdomen and pelvis did not reveal any other masses or lytic lesions. . A skeletal survey showed another 2 cm lytic lesion in the proximal left humeral metaphysis which was not biopsied. On parathyroidectomy, the patient was found to have an enlarged left inferior parathyroid gland measuring 3.3 x 3.0 x 0.8 cm weighing 7.093 grams. Intraoperatively PTH level decreased from 890 pg/mL to 69 pg/mL. Her calcium levels returned to normal post-operatively and she was discharged home. Pathologic examination report revealed the mass to be a parathyroid adenoma. The patient reports a reduction in the size of her mandible mass since the surgery. Conclusion: Although uncommon, brown tumors can be seen in uncontrolled primary hyperparathyroidism. The mandible is a common site, though, as in this case, it is less common for it to be the only site affected Reference: 1. Rosenberg, E. H. (1962). Hyperparathyroidism. A review of 220 proved cases with special emphasis on findings in the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 15(2), 84–94.

scholarly journals MON-347 Osteitis Fibrosa Cystica and Pathological Fractures: The Classic but Neglected Skeletal Manifestation of Primary Hyperparathyroidism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sirinart Sirinvaravong ◽  
Nontouch Singsumpun ◽  
Ekasame Vanitcharoenkul ◽  
Aasis Unnanuntana
Keyword(s):  
Primary Hyperparathyroidism ◽  
Osteitis Fibrosa ◽  
Pathological Fractures ◽  
Osteitis Fibrosa Cystica ◽  
Left Tibia ◽  
History Of ◽  
Brown Tumors ◽  
Skeletal Manifestation ◽  
Salt And Pepper ◽  
Pth Level

Abstract Background: Osteitis fibrosa cystica is one of the classic manifestations of primary hyperparathyroidism (PHPT), yet it has become increasingly rare due to early detection of PHPT. Clinical case: A 37-year-old woman was referred to our hospital for fixation of multiple fractures. Before transferring to our hospital, she was admitted to a local hospital due to right distal humerus and left tibial fractures without history of trauma. During the hospitalization, a new fracture at left femur had occurred. Her past medical history was significant for fractures of right shoulder, left elbow and right femur when she fell on the ground 5 years ago and treated by fixation. She had a history of kidney stones in the remote past. She denied family history of calcium or skeletal disorders. Clinical examination revealed gross deformities at right elbow, left thigh and painful swelling of the left tibia. On HEENT examination, there were no palpable neck masses. Upon review of plain radiographs from outside hospital, we found not only fractures but diffuse osteopenia and brown tumors at multiple sites including shaft of right humerus, right proximal radius, left proximal femoral shaft and left tibia. Skull X-ray showed salt-and-pepper appearance. There were prominent subendplate densities at multiple lumbar spines (Rugger-jersey spine). These findings were consistent with osteitis fibrosa cystica which prompted further laboratory investigation for PHPT. The patient had a high corrected serum calcium level of 13.6 (8.6-10.0) mg/dl, low serum phosphate of 2.2 (2.5-4.5) mg/dL, serum creatinine of 1.16 (0.51-0.95) mg/dL, glomerular filtration rate (GFR) of 60.29 ml/min, high serum alkaline phosphatase of 1,482 (35-105) U/L. The serum parathyroid hormone (PTH) level was significantly high at 3,850 (15-65) pg/mL. Vitamin D level was low at 5.98 (≥30) ng/mL. The patient was diagnosed with PHPT. The left lower parathyroid adenoma was identified by 99mTc-Sestamibi scan with single photon emission computed tomography and neck ultrasound. Given severe skeletal manifestations and extremely elevated PTH level, urgent parathyroidectomy was performed. A 2.5-cm parathyroid adenoma was removed which was histologically confirmed by a pathologist. Postoperatively, she developed a hungry bone syndrome which resolved 10 months after. Clinical lesson: In current practice, skeletal manifestation of PHPT is uncommon with a reported incidence of 1.4% in US. Osteitis fibrosa cystica is a radiographic feature of PHPT characterized by demineralized skeleton, salt-and-pepper appearance of the skull, subperiosteal resorption of the phalanges, bone cysts, and brown tumors. Although PHPT has evolved to asymptomatic disease in majority of patients, the classic skeletal involvement should not be overlooked, particularly in young patients who present with multiple pathological fractures.

scholarly journals Osteitis Fibrosa Cystica A Rare Presentation of Primary Hyperparathyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A207-A208
Author(s):  
Patricia Luengo Pierrard ◽  
Laura M Tortolero Giamate ◽  
Belén Porrero Guerrero ◽  
Joaquín Gómez Ramírez ◽  
Jordi Nuñez Nuñez
Keyword(s):  
Primary Hyperparathyroidism ◽  
Emergency Room ◽  
Parathyroid Adenoma ◽  
Calcium Metabolism ◽  
Malignant Neoplasm ◽  
Osteitis Fibrosa ◽  
Bone Lesions ◽  
Osteitis Fibrosa Cystica ◽  
Lytic Lesions ◽  
The Right

Abstract Introduction: Osteitis fibrosa cystica (OFC) is the most serious bone involvement of primary hyperparathyroidism (PHPT), it is characterized by subperiosteal resorption, lytic lesions and the appearance of brown tumors; this is why, in some cases, this condition can easily be mistaken for a malignant neoplasm. Its prevalence in developed countries is only 5%. Clinical Case: We present a 58-year-old woman, with no relevant personal history, who came to the emergency room with pain in her right shoulder after an accidental fall on the bus. The humerus radiograph shows a pathological fracture of the right humerus, with significant osteopenia. In the emergency analysis, serum Calcium 13.3 mg / d), Ionic Calcium 7.03 mg / dL, Phosphorus 2.4 mg / dL, Alkaline Phosphatase 248 U / L and normal kidney function stand out. With a diagnosis of severe hypercalcemia, treatment was started in the emergency room with serum therapy (1000 ml of 0.9% physiological saline in 4 hours) and intravenous diuretic treatment (furosemide 40mg) with a decrease in calcemia to 12.8mg / dL. Later, she was admitted to the Internal Medicine hospital ward to perform a differential diagnosis of hypercalcemia secondary to a primary tumor, Multiple Myeloma or Primary Hyperparathyroidism. The study findings are: Calcium metabolism: PTH 660 pg / ml (12 - 65), 25 Hydroxyvitamin D: 14.00. Thyroid ultrasound: Posterocaudal to right thyroid lobe, an area of ​​echogenicity slightly lower than the thyroid is identified, of dimensions not estimated by endothoracic component, which could correspond to a parathyroid adenoma. Body CT: Neck: Heterogeneous nodule dependent on the posterior region of the right thyroid nodule with endothoracic extension. Skeleton: Lytic lesions with a tumor aspect in the humerus, right scapula and bilateral seventh rib and right pubic branch. Skull: Diffuse increase in bone density of the calvaria, showing multiple punctate lytic lesions with a permeative appearance. Bone densitometry: Femur neck: - <1.5, Lumbar spine: - <3.0 With the diagnosis of PHPT causing osteitis fibrosa cystica, surgical intervention was decided. Under general anesthesia, a selective right approach was performed, finding a large parathyroid adenoma weighing 17 grams. PTH fell to 36 pg / ml after surgery. At 9 months after surgery, the patient presented calcium levels of 9 mg / dl and PTH 146 pg / ml with clear radiological improvement. Discussion: Osteitis fibrosa cystica is rare in our environment, it is often confused with other neoplasms. After parathyroidectomy, patients with PHPT have a marked and sustained recovery from OFC, although in some cases this recovery can only be achieved after several years. We consider this case of interest, since it illustrates the importance of evaluating the study of phospho-calcium metabolism and parathyroid function in all patients with bone lesions to rule out Primary Hyperparathyroidism with OFC.

scholarly journals Brown tumor due to primary hyperparathyroidism resulting in acute paraparesis: Case report and literature review

2020 ◽  
Vol 11 ◽  
pp. 355
Author(s):  
Ahmed Taha Elsayed Shaaban ◽  
Mostafa Ibrahem ◽  
Ahmed Saleh ◽  
Abdulrazzaq Haider ◽  
Abdulnasser Alyafai
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bone Lesion ◽  
Excisional Biopsy ◽  
Brown Tumor ◽  
Parathyroid Tumor ◽  
Osteitis Fibrosa Cystica ◽  
Lytic Bone Lesion ◽  
Brown Tumors ◽  
Acute Paraparesis ◽  
Operative Decompression

Background: Brown tumor (Osteoclastoma) is a rare benign, focal, lytic bone lesion most commonly attributed to a parathyroid adenoma; it occurs in approximately 5% of patients with primary hyperparathyroidism, and 13% of patients with secondary hyperparathyroidism. Most tumors are located in the mandible, pelvis, ribs, and large bones; only rarely is it found in the axial spine. Case Description: A 37-year-old male with primary hyperparathyroidism presented with an MR-documented T4 and T5 brown tumor (Osteitis Fibrosa Cystica) resulting in an acute paraparesis. The patient successfully underwent excisional biopsy of an expansile, enhancing, bony destructive lesion at the T4-5 level. Subsequently, he required subtotal excision of a left upper parathyroid tumor. Conclusion: Patient with primary hyperparathyroidism may acutely present with paraparesis attributed to brown tumors of the spine warranting emergent operative decompression.

Brown Tumors of the Mandible Revealing Hyperparathyroidism: About Two Cases

2021 ◽  
Vol 11 (12) ◽  
pp. 128-133
Author(s):  
Hela Zouaghi ◽  
Dorsaf Touil ◽  
Raouaa Belkacem Chebil
Keyword(s):  
Parathyroid Hormone ◽  
Female Patient ◽  
Case Reports ◽  
Panoramic Radiograph ◽  
Osteitis Fibrosa ◽  
Brown Tumor ◽  
Osteolytic Lesions ◽  
Osteitis Fibrosa Cystica ◽  
High Level ◽  
Pth Level

The diagnosis of osteolytic lesions of the jaws can be challenging. Case Reports: Two cases of brown tumor of hyperparathyroidism were reported. A 76- year-old female patient presented with indolent swelling of her right lower jaw measuring approximately 5 cm /6 cm. The panoramic radiograph showed a well-defined osteolytic radiolucency involving the entire mandibular symphysis. Blood investigations revealed High level of parathyroid Hormone (PTH): 102pg/ml. The diagnosis of a brown tumor of hyperparathyroidism was suspected. A parathyroid technetium scintiscan revealed abnormally high uptake at the lower pole of the thyroid lobe interpreted as hyperplasia of right inferior parathyroid gland with possible brown tumor of the mandible. Second case: A 36- year-old female patient presented for the replacement of her missing teeth. Her medical history revealed chronic renal failure and a recent surgical excision of an Osteitis fibrosa cystica of her fifth left proximal phalange. Panoramic radiograph showed multiple well defined osteolytic lesions of the mandible. The diagnosis of a brown tumor of the mandible secondary to hyperparathyroidism was suspected. Laboratory investigations showed increased PTH level, serum hypocalcemia and hyperphosphatemia and vitamin D deficiency. The patient was referred to the department of endocrinology for further investigation and the correction of PTH level. At Six months follow up all the lesions disappeared on radiological control. Discussion: Brown tumor of hyperparathyroidism is a metabolic disorder causing bone resorption that can affect the jaw bones. Clinical symptoms depend on the size and the location of the lesion. Radiographically, it appears as radiolucent unique or multiple well-defined intra-osseous radiolucency. Biological examination is the key to the diagnosis and it is marked by high level of parathyroid hormone (PTH). Key words: Jaw, Tumors, Osteitis Fibrosa Cystica, Hyperparathyroidism, Diagnosis.

scholarly journals Maxillary Brown Tumor as a Rare Complication of Hyperparathyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A205-A206
Author(s):  
Janet Colón Castellano ◽  
Nydia Ivette Burgos Ortega ◽  
Nicole Hernandez Cordero ◽  
Walter Morales Borrero ◽  
Yadiel Rivera Nieves ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Serum Calcium ◽  
Early Recognition ◽  
Rare Complication ◽  
Osteitis Fibrosa ◽  
Brown Tumor ◽  
Histologic Diagnosis ◽  
Osteitis Fibrosa Cystica ◽  
Brown Tumors ◽  
Nasal Bleeding

Abstract Secondary hyperparathyroidism is a common complication of end stage renal disease (ESRD). The inherent impaired phosphorus and calcium metabolism result in altered bone metabolism, which rarely may manifest as osteitis fibrosa cystica with approximately 2% presenting as brown tumors. Brown tumors are areas of excessive bone resorption replaced by giant cells and fibrovascular tissue. Maxillofacial brown tumors are rare and result in increased patient morbidity due to associated nasal bleeding, diffuse pain and focal deformities. Nonetheless, these tumors are treatable and may regress following reduced parathyroid hormone (PTH) levels. Case of a 64-years-old Hispanic male with history of ESRD on hemodialysis for more than 20 years, secondary hyperparathyroidism with fragility fractures of femur status post parathyroidectomy on years 1999 and 2010, coronary artery disease and hypertension, who was consulted to our service for evaluation of a bleeding nasal septum mass suspected of a brown tumor. The patient presented to the emergency room with a massive spontaneous nasal bleeding which was subsequently controlled and evaluated by imaging. Maxillofacial CT scan without contrast showed an expansile soft tissue mass at the right maxillary sinus measuring 3.4 x 3.5 x 3.7 cm with innumerable, similar lesions distributed throughout the cranial, cervical and visualized portions of the shoulder girdle bones. Biochemical evaluation was remarkable for PTH levels 1,229 pg/ml (nl, 18.5 – 88.0 pg/ml), corrected serum calcium 9.0 mg/dl (nl, 8.3 – 10.6 mg/dl), alkaline phosphate levels 391 U/L (nl, 46 – 116 U/L), serum phosphoros 5.5 mg/dl (nl, 2.5 – 4.5 mg/dl), calciferol levels 32.2 ng/ml (nl, 30 – 100 ng/ml) and an estimated glomerular filtration rate at 21 ml/min/1.73 m2 (nl, > 60 ml/min/1.73 m2). An excisional tissue biopsy showed osteoclastic-like multinucleated cells consistent with a brown tumor. These findings are consistent with secondary hyperparathyroidism complicated with osteitis fibrosa cystica. Following histologic diagnosis, a 99mTc-Sestamibi parathyroid scan showed two focal lesions of increased radiotracer uptake in the lower poles of the thyroid confirming parathyroid hyperplasia. Patient’s medical therapy was optimized by increasing cinacalcet dose and adding calcitriol, while continuing Sevelamer. Serum calcium, PTH, and phosphorous levels were closely monitored. Finally, patient was referred for parathyroidectomy. Patients with ESRD are at high risk of developing secondary hyperparathyroidism. Even with prior parathyroidectomy, these patients can develop disease recurrence. Early recognition and management of secondary hyperparathyroidism is crucial to decrease disease complications such as Brown tumors.

A Case of Primary Hyperparathyroidism Associated with Brown Tumor of the Right Patella

2013 ◽  
Vol 64 (3) ◽  
pp. 224-230
Author(s):  
Masanori Teshima ◽  
Shigemichi Iwae ◽  
Yuji Hirayama ◽  
Hirotaka Shinomiya ◽  
Tatsuya Furukawa
Keyword(s):  
Primary Hyperparathyroidism ◽  
Brown Tumor ◽  
The Right

scholarly journals Severe bone disease caused by primary hyperparathyroidism: a case report and review of the literature

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096648
Author(s):  
Yu Wang ◽  
Jie Liu
Keyword(s):  
Case Report ◽  
Primary Hyperparathyroidism ◽  
Bone Disease ◽  
Distal Humerus ◽  
Left Lobe ◽  
Pathological Examination ◽  
Hypoechoic Mass ◽  
Brown Tumors ◽  
Restricted Mobility ◽  
The Right

Bone disease is an important complication of hyperparathyroidism. We herein report a rare case of severe bone disease caused by primary hyperparathyroidism. A 33-year-old man presented with pain and restricted mobility in his right upper limb and right hip due to a fall 3 days previously. X-ray examination showed a fracture of the proximal and distal humerus. Computed tomography examination showed a supracondylar fracture of the right humerus, a fracture of the right femoral neck, a fracture of the right sciatic branch, and multiple brown tumors. Ultrasonography showed a 3.5- × 1.6-cm hypoechoic mass below the left lobe of the thyroid. The patient was diagnosed with primary hyperparathyroidism based on increased serum calcium and parathormone concentrations, pathological fractures, and multiple brown tumors. He therefore underwent bilateral lower parathyroidectomy. Pathological examination revealed a parathyroid adenoma. The patient recovered well after surgery and was followed up for 6 months with no symptoms of hyperparathyroidism. This case report suggests that clinicians should be aware of the possibility of severe bone disease secondary to primary hyperparathyroidism. Active and early diagnosis and surgical treatment are important in such cases.

scholarly journals Molecular Imaging with 18F-FDG PET/CT and 99mTc-MIBI SPECT/CT in Osteitis Fibrosa Cystica Generalisata

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1355
Author(s):  
Adrien Holzgreve ◽  
Matthias P. Fabritius ◽  
Thomas Knösel ◽  
Lena M. Mittlmeier ◽  
Johannes Rübenthaler ◽  
...  
Keyword(s):  
Molecular Imaging ◽  
Fdg Pet ◽  
Correct Diagnosis ◽  
Osteitis Fibrosa ◽  
Osteitis Fibrosa Cystica ◽  
Pet Ct ◽  
Brown Tumors ◽  
18F Fdg ◽  
99Mtc Mibi ◽  
Fdg Pet Ct

Benign so-called “brown tumors” secondary to hyperparathyroidism are a rare diagnostic pitfall due to their impressively malignant-like character in various imaging modalities. We present the case of a 65-year-old male patient with multiple unclear osteolytic lesions on prior imaging suspicious for metastatic malignant disease. Eventually, findings of 18F-FDG PET/CT staging and 99mTc-MIBI scintigraphy resulted in revision of the initially suspected malignant diagnosis. This case illustrates how molecular imaging findings non-invasively corroborate the correct diagnosis of osteitis fibrosa cystica generalisata with the formation of multiple benign brown tumors.

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