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 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.

Healing Of A Large Osteolytic Mandibular Lesion – A Case Report

2018 ◽  
Author(s):  
Ingrid Różyło-Kalinowskav ◽  
Karolina Sidor
Keyword(s):  
Case Report ◽  
Female Patient ◽  
Surgical Approach ◽  
Orthodontic Treatment ◽  
Incidental Finding ◽  
Osteolytic Lesion ◽  
Panoramic Radiograph ◽  
Endodontic Treatment ◽  
Osteolytic Lesions

The purpose of this article was to present a case report of 11–year old female patient with a large osteolytic mandibular lesion which healed after endodontic treatment. The patient was referred for radio diagnostics due to an incidental finding of a large osteolytic lesion of the area of the left lower first and second premolars in the panoramic radiograph taken before orthodontic treatment. CBCT was performed and the patient asked to have teeth 33-35 treated by endodontics before surgery. The patient missed the surgical appointment and when she reappeared several months later, the lesion showed signs of healing thus surgery were aborted. The presented case testifies to the observation that even large osteolytic lesions can heal after endodontic treatment without surgical approach.

scholarly journals An Unusual Presentation of Primary Hyperparathyroidism: Pathological Fracture

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Ben Abdelghani Khaoula ◽  
Ben Abdelghani Kaouther ◽  
Chelly Ines ◽  
Turki Sami ◽  
Leith Zakraoui ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Female Patient ◽  
Calcium Level ◽  
Pathological Fracture ◽  
Unusual Presentation ◽  
Uneventful Recovery ◽  
Brown Tumor ◽  
Pathological Findings ◽  
Pth Level

Primary hyperparathyroidism revealed by a pathological fracture is very uncommon. We present a case of a 54-year-old female patient who was admitted with fracture of her right femur. She underwent closed intramedullary reconstruction nailing with bipolar locking. The pathological findings confirmed the diagnosis of primary hyperparathyroidism with brown tumor. Further tests showed increased both calcium level and PTH level. A parathyroidectomy was performed. She made an uneventful recovery and was discharged to home.

Fine Needle Aspiration Diagnosis of Osteitis Fibrosa Cystica (Brown Tumor of Bone)

2008 ◽  
Vol 52 (4) ◽  
pp. 471-474 ◽  
Author(s):  
Anna M. Collins Kemp ◽  
Meliha Bukvic ◽  
Charles D. Sturgis
Keyword(s):  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Osteitis Fibrosa ◽  
Brown Tumor ◽  
Osteitis Fibrosa Cystica ◽  
Fine Needle

RADIOLOGIC MANIFESTATION OF BONE INVOLVEMENT IN PRIMARY HYPERPARATHYROIDISM: PREVALENCE AND CLINICAL SIGNIFICANCE IN A SOUTHERN EUROPEAN SERIES

2020 ◽  
Vol 26 (9) ◽  
pp. 983-989
Author(s):  
Elena Castellano ◽  
Roberto Attanasio ◽  
Alberto Boriano ◽  
Valentina Borretta ◽  
Marta Gennaro ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Bone Involvement ◽  
Osteitis Fibrosa ◽  
Mineral Density ◽  
Osteitis Fibrosa Cystica ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Objective: Clinically overt symptomatic bone disease in primary hyperparathyroidism (PHPT) is rarely seen today, and osteoporosis is the dominant finding. Subperiosteal bone resorption in the fingers and skull mottling are typical bone PHPT findings, the contemporary prevalence of which is unknown. We evaluated these mild lesions and investigated the impact of their occurrence on PHPT clinical management. Methods: We evaluated retrospectively a monocentric series of 363 PHPT patients classified in Group 1 (n = 100) or Group 2 (n = 263) according to the presence or absence of bone involvement, respectively. Patients belonging to Group 1, in turn, were subdivided into Group 1A, with severe and symptomatic lesions (n = 48), and Group 1B, with milder signs of osteitis fibrosa cystica (OFC) without brown tumors or fractures (n = 52). Results: Serum total and ionized calcium, parathyroid hormone, osteocalcin, alkaline phosphatase, and its bone fraction levels were higher in Group 1 than in Group 2, while no gender or age differences were observed between the groups. Osteoporosis prevalence was similar in Group 1B and Group 2 patients but lower than in Group 1A. Mild OFC findings did not modify the surgical indication in any patient of Group 1B. Conclusion: Minor radiologic signs of OFC are not uncommon in the modern PHPT phenotype and occur in patients with more active disease. These signs could identify PHPT patients in an earlier stage of typical bone involvement. However, these features do not seem to upgrade either the clinical classification of asymptomatic PHPT patients or the propensity toward surgical choice. Abbreviations: 25OHD = 25-hydroxyvitamin D; ALP = alkaline phosphatase; bALP = bone-specific alkaline phosphatase; BMD = bone mineral density; eGFR = estimated glomerular filtration rate; OFC = osteitis fibrosa cystica; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; VF = vertebral fracture

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.

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