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Staouni IB, Haloua M, Nizar B, Alami BE, Lamrani YA, Maâroufi M, Boubbou M. Primary hyperparathyroidism presenting as a brown tumor in the mandible: A case report. Radiol Case Rep 2022; 17:2283-2286. [PMID: 35574569 PMCID: PMC9092295 DOI: 10.1016/j.radcr.2022.03.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 11/25/2022] Open
Abstract
A brown tumor is a non-neoplastic lesion resulting from an abnormality of bone metabolism in the context of hyperparathyroidism. We report the case of a 51-year-old woman who initially consulted for edentulism and a growing mandibular mass. She benefited from a radiological and biological assessment which made the diagnosis of primary hyperparathyroidism combined with a parathyroid adenoma. We remind through this observation the difficulty to establish a correct diagnosis in patients with an osteolytic process of the maxilla and the necessity to look for hyperparathyroidism in front of a giant cell lesion given the insidious character of this endocrinopathy.
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Affiliation(s)
- Imane Benabdallah Staouni
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Meryem Haloua
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Bouardi Nizar
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Badr-Eddine Alami
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Youssef Alaoui Lamrani
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Mustapha Maâroufi
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Meryem Boubbou
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
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Bersenev GA, Ilyicheva EA, Griroryev EG. [The case of late diagnosis of giant parathyroid adenoma in combination with fibrocystic osteitis and brown tumor of the upper jaw: a case report]. ACTA ACUST UNITED AC 2021; 67:49-56. [PMID: 34004103 PMCID: PMC8926140 DOI: 10.14341/probl12713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/15/2021] [Accepted: 03/14/2021] [Indexed: 12/19/2022]
Abstract
In this case report the authors inform about late diagnosis of giant adenoma of the parathyroid gland with primary hyperparathyroidism (PHPT) and the development of fibrocystic osteitis with a «brown» tumor of the upper jaw. The patient has been under the care endocrinologist with type 2 diabetes mellitus and multinodular goiter for 8 years.The last 5 years there was a clinical manifestation of PHPT, but the diagnosis was made by an oncologist after the detection of a «brown» tumor of the upper jaw. According to multispiral computed tomography and scintigraphy with 99mTc-MIBI, a focal lesion was found in the upper jaw on the right, lytic foci in the bones of the cranial vault, pelvis, lower extremities, ribs on the right, as well as a giant parathyroid adenoma on the right. According to the increased risk of the patient having a malignant neoplasm of the parathyroid gland, an extended surgical treatment of PHPT in the enblock volume was carried out with the achievement of remission of the PHPT. This clinical case illustrates a variant of the severe course of PHPT with the development of such a rare complication as fibrocystic osteitis and demonstrates the importance of timely diagnosis.
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Affiliation(s)
- G A Bersenev
- Irkutsk Scientific Centre of Surgery and Traumatology
| | - E A Ilyicheva
- Irkutsk Scientific Centre of Surgery and Traumatology
| | - E G Griroryev
- Irkutsk Scientific Centre of Surgery and Traumatology; Irkutsk State Medical University
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Xu B, Yu J, Lu Y, Han B. Primary hyperparathyroidism presenting as a brown tumor in the mandible: a case report. BMC Endocr Disord 2020; 20:6. [PMID: 31931802 PMCID: PMC6956496 DOI: 10.1186/s12902-019-0480-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/20/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Primary hyperparathyroidism is characterized by hypercalcemia and elevated or inappropriately normal serum levels of parathyroid hormone. Brown tumor of bone is a rare non-neoplastic lesion resulted from abnormal bone metabolism in hyperparathyroidism. However, nowadays, skeletal disease caused by primary hyperparathyroidism is uncommon. We report a case of brown tumor in the mandible as the initial exhibition of primary hyperparathyroidism associated with an atypical parathyroid adenoma. CASE PRESENTATION The patient was a 49-year-old female, she had a pain mass on the right mandible a year ago and was treated with root canal therapy and marginal resection. After seven months, the mass recurred and enlarged. Enhanced CT scan, laboratory examination, Ultrasonography, 99mTc-MIBI SPECT-CT scintiscan and pathological examination were used to confirm the diagnosis of brown tumor. The patient's symptom improved after parathyroidectomy. CONCLUSIONS 99mTc-MIBI SPECT/CT scintigraphy is a highly sensitive examination of the localization diagnosis of hyperparathyroidism. Brown tumors should be considered in the differential diagnosis of osteolytic lesions to avoid unnecessary and harmful interventions.
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Affiliation(s)
- Bojin Xu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Endocrinology, Shanghai Tongren Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Yu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Bing Han
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Gnathic Bones and Hyperparathyroidism: A Review on the Metabolic Bony Changes Affecting the Mandible and Maxilla in case of Hyperparathyroidism. Adv Med 2020; 2020:6836123. [PMID: 32695835 PMCID: PMC7368230 DOI: 10.1155/2020/6836123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 06/05/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
Parathyroid glands secrete the parathyroid hormone that plays an essential role in bone remodeling. Excessive production of parathyroid hormone causes a common metabolic bone disorder known as hyperparathyroidism that is classified into primary, secondary, or tertiary. In hyperparathyroidism, the late bony complication is manifested as a giant cell osteolytic lesion called "brown tumor." Primary hyperparathyroidism is usually a sporadic disorder, but in minority of cases it occurs in inherited forms, and one of these forms is the hyperparathyroidism-jaw tumor syndrome, which is characterized by primary hyperparathyroidism and ossifying fibroma in the mandible and/or maxilla.
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Manjunatha BS, Purohit S, Harsh A, Vangala N. A complex case of brown tumors as initial manifestation of primary hyperparathyroidism in a young female. J Oral Maxillofac Pathol 2019. [PMID: 31942141 DOI: 10.4103/jomfp.jomfp_166_19.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Brown tumor is one of the lesions that develop in patients with hyperparathyroidism (HPT) and represents the terminal stages of bone remodeling process. Any of the skeletal bones can be affected including the craniomaxillofacial ones. Many a times, brown tumor was detected after a final diagnosis of HPT is made. However, on occasions, brown tumor can be the first clinical sign of the disease. Primary HPT is an uncommon systemic disease usually caused by hyperplasia or adenoma of the parathyroid glands. It causes overproduction of parathormone, which may affect the entire skeleton, causing bone resorption appear as cyst-like lesions called osteitis fibrosa cystica or brown tumors. Here, we report such a rare case in which multiple radiolucent lesions were noticed in the ramus part of the mandible and premolar region bilaterally, as the initial signs of primary HPT are presented in this report.
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Affiliation(s)
- Bhari Sharanesha Manjunatha
- Department of Oral Biology, Basic Oral Medicine and Allied Dental Sciences Division, College of Dentistry, Al-Hawaiya, AtTaif, Taif University, Taif, Saudi Arabia
| | - Sharad Purohit
- Department of Oral Pathology and Microbiology, Haldia Institute of Dental Sciences and Research, Halda, West Bengal, India
| | - Ashutosh Harsh
- Department of Dentistry, Jhalawar Medical College and Hospital, Jhalawar, Rajasthan, India
| | - Nagamahita Vangala
- Department of Oral Pathology and Microbiology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
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Manjunatha BS, Purohit S, Harsh A, Vangala N. A complex case of brown tumors as initial manifestation of primary hyperparathyroidism in a young female. J Oral Maxillofac Pathol 2019; 23:477. [PMID: 31942141 PMCID: PMC6948047 DOI: 10.4103/jomfp.jomfp_166_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Brown tumor is one of the lesions that develop in patients with hyperparathyroidism (HPT) and represents the terminal stages of bone remodeling process. Any of the skeletal bones can be affected including the craniomaxillofacial ones. Many a times, brown tumor was detected after a final diagnosis of HPT is made. However, on occasions, brown tumor can be the first clinical sign of the disease. Primary HPT is an uncommon systemic disease usually caused by hyperplasia or adenoma of the parathyroid glands. It causes overproduction of parathormone, which may affect the entire skeleton, causing bone resorption appear as cyst-like lesions called osteitis fibrosa cystica or brown tumors. Here, we report such a rare case in which multiple radiolucent lesions were noticed in the ramus part of the mandible and premolar region bilaterally, as the initial signs of primary HPT are presented in this report.
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Affiliation(s)
- Bhari Sharanesha Manjunatha
- Department of Oral Biology, Basic Oral Medicine and Allied Dental Sciences Division, College of Dentistry, Al-Hawaiya, AtTaif, Taif University, Taif, Saudi Arabia
| | - Sharad Purohit
- Department of Oral Pathology and Microbiology, Haldia Institute of Dental Sciences and Research, Halda, West Bengal, India
| | - Ashutosh Harsh
- Department of Dentistry, Jhalawar Medical College and Hospital, Jhalawar, Rajasthan, India
| | - Nagamahita Vangala
- Department of Oral Pathology and Microbiology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
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Popovik-Monevska D, Bozovik-Dvojakovska S, Popovski V, Benedetti A, Grchev A, Koneski F. Brown Tumour in the Mandible and Skull Osteosclerosis Associated with Primary Hyperparathyroidism - A Case Report. Open Access Maced J Med Sci 2018. [PMID: 29531614 PMCID: PMC5839458 DOI: 10.3889/oamjms.2018.086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND: The hyperparathyroidism (HPT) is a condition in which the parathyroid hormone (PTH) levels in the blood are increased. HPT is categorised into primary, secondary and tertiary. A rare entity that occurs in the lower jaw in association with HPT is the so-called brown tumour, which an osteolytic lesion is predominantly occurring in the lower jaw. It is usually a manifestation of the late stage of the disease. Osteosclerotic changes in other bones are almost always associated with renal osteodystrophy in secondary HPT and are extremely rare in primary HPT. This article reports a rare case of a brown tumour in the mandible as the first sign of a severe primary HPT, associated with osteosclerotic changes on the skull. CASE REPORT: A brown tumour in the mandible was diagnosed in 60 - year old female patient with no previous history of systemic disease. The x - rays showed radiolucent osteolytic lesion in the frontal area of the mandible affecting the lamina dura of the frontal teeth, and skull osteosclerosis in the form of salt and pepper sign. The blood analyses revealed increased values of PTH, calcitonin and β – cross-laps, indicating a primary HPT. The scintigraphy of the parathyroid glands showed a presence of adenoma in the left lower lobe. The tumour lesion was surgically removed together with the lower frontal teeth, and this was followed by total parathyroidectomy. The follow - up of one year did not reveal any signs of recurrence. CONCLUSION: It is critical to ensure that every osteolytic lesion in the maxillofacial region is examined thoroughly. Moreover, a proper and detailed systemic investigation should be performed. Patients should undergo regular check-ups to prevent late complications of HPT.
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Affiliation(s)
- Danica Popovik-Monevska
- Department of Maxillofacial Surgery, Faculty of Dental Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Suzana Bozovik-Dvojakovska
- Department of Maxillofacial Surgery, Faculty of Dental Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Vladimir Popovski
- Department of Maxillofacial Surgery, Faculty of Dental Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Alberto Benedetti
- Department of Maxillofacial Surgery, Faculty of Dental Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Aleksandar Grchev
- Department of Maxillofacial Surgery, Faculty of Dental Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Filip Koneski
- Department of Oral Surgery, Faculty of Dental Medicine, Ss. Cyril and Methodius, University of Skopje, Skopje, Republic of Macedonia
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Sharma R, Bhanupriya, Bhartiya V, Guleria K, Suneja A. Hyperparathyroidism during Pregnancy- A Diagnostic and Therapeutic Challenge. J Clin Diagn Res 2017; 11:QD05-QD07. [PMID: 29207788 DOI: 10.7860/jcdr/2017/25948.10688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
Abstract
Primary Hyperparathyroidism (PHP) is a rare event in pregnancy; Maternal complications in PHP patients can be as high as 67%. It can be overlooked easily because of many similar complaints shared by hyperparathyroidism and pregnancy such as nausea and vomiting, gastritis, bone aches, easy fatigability. Hypercalcemic crisis can develop resulting in coma and death. Neonatal effects are tetany and death in about 80% of cases. We report a case, of an antenatal woman at 30 weeks gestation with complains of painful swelling in left lower jaw and below right knee, pain over right hip joint and frequent episodes of gastritis. She was finally diagnosed to have primary hyperparathyroidism and brown tumour due to parathyroid adenoma. The baby was kept in Neonatal Intensive Care Unit (NICU) for three weeks, in view of prematurity with respiratory distress and later developed sepsis with DIC. The patient's signs and symptoms regressed after parathyroid surgery and the baby was healthy at the time of discharge. This case highlights the progressive deterioration of the patient because of lack of awareness of this disease process and its impact on maternal and foetal morbidity.
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Affiliation(s)
- Richa Sharma
- Assistant Professor, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital, Delhi, India
| | - Bhanupriya
- Assistant Professor, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital, Delhi, India
| | - Vishnu Bhartiya
- Assistant Professor, Department of Obstetricsand Gynaecology, UCMS and GTB Hospital, Delhi, India
| | - Kiran Guleria
- Director Professor, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital, Delhi, India
| | - Amita Suneja
- Director Professor and Head, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital, Delhi, India
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Talukder S, Behera A, Bhadada SK, Mitra S. Giant mediastinal parathyroid adenoma presenting as bilateral brown tumour of mandible: a rare presentation of primary hyperparathyroidism. BMJ Case Rep 2017; 2017:bcr-2017-220722. [PMID: 29066636 DOI: 10.1136/bcr-2017-220722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hyperparathyroidism (HPT) is becoming increasingly common endocrinopathy in clinical practice. Nowadays, it is mostly diagnosed in subclinical or early clinical stage. Bony involvement in HPT has seen significant fall in incidence. Brown tumour of bone is exceptionally rare as a first manifestation of primary HPT (PHPT). Its radiological and histopathological features may be mistaken for other bony pathologies. If possibility of underlying HPT is overlooked the disease is bound to recur after surgery adding to morbidity of the patient. Here we present a case of bilateral brown tumour of mandible which was mistakenly treated as giant cell granuloma by surgical curettage. That the patient was harbouring an ectopic parathyroid adenoma with hypercalcemia causing non-specific symptoms was missed by the referring physician. This led to recurrence of the lesion. On subsequent evaluation, a giant mediastinal parathyroid adenoma causing PHPT was detected at our centre and was removed via mini sternotomy approach.
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Affiliation(s)
- Shibojit Talukder
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunanshu Behera
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suvradeep Mitra
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Brabyn P, Capote A, Belloti M, Zylberberg I. Hyperparathyroidism Diagnosed Due to Brown Tumors of the Jaw: A Case Report and Literature Review. J Oral Maxillofac Surg 2017; 75:2162-2169. [DOI: 10.1016/j.joms.2017.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
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Systematic review of oral manifestations related to hyperparathyroidism. Clin Oral Investig 2017; 22:1-27. [DOI: 10.1007/s00784-017-2124-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 05/10/2017] [Indexed: 12/29/2022]
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12
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An Endocrine Jaw Lesion: Dentist Perspective in Diagnosis. Case Rep Dent 2016; 2016:2582038. [PMID: 27974979 PMCID: PMC5126398 DOI: 10.1155/2016/2582038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 09/26/2016] [Indexed: 11/17/2022] Open
Abstract
Brown tumor is a rare nonneoplastic focal giant cell lesion that occurs in hyperparathyroidism patients with a prevalence rate of 0.1% in jaws. We report an extremely rare case of brown tumor in mandible of a 40-year-old female patient that presented as the first clinical manifestation of hyperparathyroidism. Dentist played a pivotal role in the present case by the early diagnosis of lesion and its intervention.
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Mandibular Brown Tumor of Secondary Hyperparathyroidism Requiring Extensive Resection: A Forgotten Entity in the Developed World? Case Rep Med 2015; 2015:567543. [PMID: 26413096 PMCID: PMC4556817 DOI: 10.1155/2015/567543] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 08/05/2015] [Indexed: 12/22/2022] Open
Abstract
Brown tumor of hyperparathyroidism (BTHPT) is rare in the United States and not frequently seen in clinical practice. This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT. Conversely, BTHPT is more common in underdeveloped countries where fewer patients have access to health care and hyperparathyroidism (HPT) goes untreated. It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT. We present a case report of a patient in the United States with a large mandibular BTHPT requiring an extensive resection in the setting of secondary HPT. Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.
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Huang R, Zhuang R, Liu Y, Li T, Huang J. Unusual presentation of primary hyperparathyroidism: report of three cases. BMC Med Imaging 2015; 15:23. [PMID: 26179753 PMCID: PMC4504063 DOI: 10.1186/s12880-015-0064-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 06/02/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism is an endocrinopathic condition characterized by hypersecretion of parathyroid hormone. Excess parathyroid hormone results in an altered state of osseous metabolism involving bone resorption and tissue change known as osteitis fibrosa cystica, which is the end stage of primary hyperparathyroidism. Osteitis fibrosa cystica is associated with the development of brown tumors, which are rare because hyperparathyroidism is now usually diagnosed and treated before symptoms develop. Brown tumors are rarely the first symptom of hyperparathyroidism and can occasionally be mistaken for malignancy. CASE PRESENTATION We herein report three cases of primary hyperparathyroidism with an unusual presentation of brown tumors. All three patients were Asian. In the first case, a 42-year-old man was admitted with a mass mimicking a malignant bone neoplasm in the right mandible as the first manifestation of primary hyperparathyroidism. The second case involved a 25-year-old man admitted with a fracture of his right femur. The third case involved a 43-year-old man with multiple brown tumors in both lower limbs. All three patients underwent successful parathyroidectomy for parathyroid adenomas; one case was complicated by a papillary thyroid carcinoma. CONCLUSION Complete evaluation of the medical history and biochemical and radiographic findings is necessary to achieve a correct diagnosis and avoid unnecessary bone resections in patients with primary hyperparathyroidism.
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Affiliation(s)
- Ruibin Huang
- Department of Radiology, The First Affiliated Hospital of the Medical College of Shantou University, Shantou, China.
| | - Ruyao Zhuang
- Department of Radiology, The First Affiliated Hospital of the Medical College of Shantou University, Shantou, China.
| | - Yuan Liu
- Department of Radiology, The First Affiliated Hospital of the Medical College of Shantou University, Shantou, China.
| | - Tianti Li
- Department of Pathology, The First Affiliated Hospital of the Medical College of Shantou University, Shantou, China.
| | - Jiexiong Huang
- Department of Pathology, The First Affiliated Hospital of the Medical College of Shantou University, Shantou, China.
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16
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Esselmani H, Bouabdellah M, Benchekroun L, Elalami S, Handor N, Chabraoui L. [The interest in the assay of serum calcium before a maxillary tumor: discovery of primary hyperparathyroidism]. Pan Afr Med J 2014; 18:315. [PMID: 25469208 PMCID: PMC4247893 DOI: 10.11604/pamj.2014.18.315.4967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 08/10/2014] [Indexed: 11/22/2022] Open
Abstract
L'hyperparathyroïdie primaire (HPP) est une affection fréquente, aujourd'hui découverte fortuitement dans 75 à 80% des cas par un dosage systématique de la calcémie biologique. Le diagnostic de cette affection se base sur la mise en évidence concomitante d'une calcémie élevée, d'un taux de parathormone (PTH) élevé (80% des cas) ou normal (20% des cas), et d'une calciurie supérieure à 150 mg/24 heures. Les manifestations squelettiques graves (ostéite fibrokystique, tumeurs brunes, fractures pathologiques) sont rares de nos jours. Les tumeurs brunes constituent un mode de révélation rare de l'hyperparathyroïdie primaire et leur localisation au niveau des maxillaires est exceptionnelle. Nous rapportons ici la longue histoire de la maladie d'un homme de 42 ans atteint d'une hyperparathyroïdie primitive découverte devant une tuméfaction jugale, une hypercalcémie majeure à 3.92 mmol/l et une tumeur brune maxillaire et nous soulignant le rôle du bilan biologique raisonné et de son interprétation en tant que révélateur diagnostique pour orienter le clinicien vers l'hyperparathyroïdie primaire.
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Affiliation(s)
- Hicham Esselmani
- Laboratoire Central de Biochimie Clinique, Hôpital Ibn Sina, Rabat, Maroc
| | - Mounya Bouabdellah
- Laboratoire Central de Biochimie Clinique, Hôpital Ibn Sina, Rabat, Maroc ; Faculté de Médecine et de Pharmacie de Rabat, Maroc
| | - Laila Benchekroun
- Laboratoire Central de Biochimie Clinique, Hôpital Ibn Sina, Rabat, Maroc ; Faculté de Médecine et de Pharmacie de Rabat, Maroc
| | - Sanae Elalami
- Laboratoire Central de Biochimie Clinique, Hôpital Ibn Sina, Rabat, Maroc
| | - Najat Handor
- Laboratoire Central de Biochimie Clinique, Hôpital Ibn Sina, Rabat, Maroc
| | - Layachi Chabraoui
- Laboratoire Central de Biochimie Clinique, Hôpital Ibn Sina, Rabat, Maroc ; Faculté de Médecine et de Pharmacie de Rabat, Maroc
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Sia HK, Hsieh MC, Yang LH, Tu ST. Maxillary brown tumor as initial presentation of parathyroid adenoma: A case report. Kaohsiung J Med Sci 2012; 28:400-3. [DOI: 10.1016/j.kjms.2012.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 04/19/2011] [Indexed: 11/17/2022] Open
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Thomas S, Nair P, Hegde K, Neelakantan S. A bilaterally recurring exophytic mass on the lower jaw. BMJ Case Rep 2011; 2011:bcr.09.2010.3362. [PMID: 22689854 DOI: 10.1136/bcr.09.2010.3362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Brown tumour is a rare focal giant-cell lesion that arises as a direct result of the effect of parathyroid hormone on bone tissue in patients with hyperparathyroidism (HPT). The lesions localise in areas of intense bone resorption, and the bone defect becomes filled with fibroblastic tissue. It can affect the mandible, maxilla, clavicle, ribs and pelvic bones. Therefore, diagnosis requires a systemic investigation for lesion differentiation. The authors present a case of a 27-year-old woman, with a rare case of brown tumour of mandible due to HPT secondary to osteomalacia. The lesion showed a tendency to recur even after excision till her parathyroid levels became normal.
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Affiliation(s)
- Shaji Thomas
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
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Pace C, Crosher R. Simultaneously occurring brown tumours in the mandible and maxilla in a patient with vitamin D deficiency. Aust Dent J 2010; 55:453-6. [DOI: 10.1111/j.1834-7819.2010.01269.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alhusban M, Baqain ZH. Mandibular brown tumor as the first manifestation of primary hyperparathyroidism: A case report. Saudi Dent J 2010; 23:107-9. [PMID: 24151418 DOI: 10.1016/j.sdentj.2010.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/11/2010] [Accepted: 11/15/2010] [Indexed: 11/25/2022] Open
Abstract
Patients with primary hyperparathyroidism (brown tumor) are usually asymptomatic and clinical presentation of the tumor in the jaws is rarely the first sign of the disease. We report a 45-year-old female patient who presented with a mandibular swelling as the first sign of the disease.
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Affiliation(s)
- Muna Alhusban
- Oral and Maxillofacial Department, Al Basheer Hospital, PO Box 13930, Amman 1942, Jordan
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Angadi PV, Rekha K, Shetty SR. “An exophytic mandibular brown tumor”: an unusual presentation of primary hyperparathyroidism. Oral Maxillofac Surg 2009; 14:67-9. [PMID: 19943073 DOI: 10.1007/s10006-009-0186-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Punnya V Angadi
- Oral & Maxillofacial Pathology, KLE VK institute of Dental Sciences and Hospital, Belgaum, India.
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Selvi F, Cakarer S, Tanakol R, Guler SD, Keskin C. Brown tumour of the maxilla and mandible: a rare complication of tertiary hyperparathyroidism. Dentomaxillofac Radiol 2009; 38:53-8. [PMID: 19114425 DOI: 10.1259/dmfr/81694583] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hyperparathyroidism is nowadays diagnosed early and asymptomatically with the improvements in routine biochemical tests and radiological procedures. The late bony complications of the disease have therefore started to decline rapidly. Brown tumours are one of the bony complications of hyperparathyroidism. The mandible is the predominantly affected site in the maxillofacial area. Maxillary involvement is rare. Here, an extremely rare case of a 19-year-old male patient with brown tumours in his maxilla and mandible associated with tertiary hyperparathyroidism is presented. A thorough diagnostic work-up was carried out and treatment options for both hyperparathyroidism and brown tumours were discussed. The importance of different radiological evaluation methods and the consultation between the oral and maxillofacial surgeons, general practitioner dentists, endocrinologists and radiologists are emphasised.
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Affiliation(s)
- F Selvi
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey.
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Reséndiz-Colosia JA, Rodríguez-Cuevas SA, Flores-Díaz R, Juan MHS, Gallegos-Hernández JF, Barroso-Bravo S, Gómez-Acosta F. Evolution of maxillofacial brown tumors after parathyroidectomy in primary hyperparathyroidism. Head Neck 2008; 30:1497-504. [DOI: 10.1002/hed.20905] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Dinkar AD, Sahai S, Sharma M. Primary hyperparathyroidism presenting as an exophytic mandibular mass. Dentomaxillofac Radiol 2007; 36:360-3. [PMID: 17699707 DOI: 10.1259/dmfr/19204128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 36-year-old female patient presented with a massive painless swelling in the left mandible. The patient's medical history was unremarkable. The initial clinical and radiological evaluation indicated an aggressive odontogenic neoplasm or a metastasis from an unknown primary; the suspicion of a systemic metabolic or endocrine disorder lay low on the list of differential diagnoses. Further investigations revealed gross skeletal changes and a hypoechoic right parathyroid mass. The total serum parathyroid hormone levels and ultrasound-guided fine needle aspiration cytology (FNAC) of the mandibular and parathyroid lesions provided the diagnosis of primary hyperparathyroidism presenting as a mandibular brown tumour. This case thus highlights the importance of a thorough diagnostic work-up for all lesions in the maxillofacial region and also serves to add another facet to the myriad of presentations associated with primary hyperparathyroidism.
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Affiliation(s)
- A D Dinkar
- Oral Medicine, Diagnosis and Radiology Department, Goa Dental College and Hospital, Bambolim, Goa 403 202, India
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Cebesoy O, Karakok M, Arpacioglu O, Baltaci ET. Brown tumor with atypical localization in a normocalcemic patient. Arch Orthop Trauma Surg 2007; 127:577-80. [PMID: 17377798 DOI: 10.1007/s00402-007-0302-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Indexed: 02/09/2023]
Abstract
Brown tumor is a bone lesion secondary to hyperparathyroidism of various etiologies. It is frequently seen in the head and neck region. Brown tumor presents itself on foot very rarely. Hyperparathyroidism is usually associated with high levels of calcium. Being normocalcemic and having the tumor on foot only without any other skeletal system involvement have led to a difficulty in establishing the diagnosis in our case. In our case, Brown tumor was surgically resected en-bloc and reconstructed with nonvascularized tricortical iliac crest. This is the first case in the literature with regard to its localization. Even though serum calcium levels are routinely checked in many clinics parathormone levels should also be looked for differential diagnosis, as this case confirms, in cases with osteolytic bone tumors that causes expansion even if the patient is normocalcemic.
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Affiliation(s)
- Oguz Cebesoy
- Orthopedic and Traumatology Department, Gaziantep University Faculty of Medicine, 27060 Gaziantep, Turkey.
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Desigan S, Syed R, Conway GS, Kurzawinski TR, Bomanji JB. Giant cervical parathyroid adenoma mimicking a sternocleidomastoid mass and presenting as a brown tumor of the mandible. Clin Nucl Med 2007; 32:306-8. [PMID: 17413582 DOI: 10.1097/01.rlu.0000257293.00744.3c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sharmini Desigan
- Institute of Nuclear Medicine, University College Hospital, London, United Kingdom
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Pahlavan PS, Severin MC. Parathyroid carcinoma: A rare case with mandibular brown tumor. Wien Klin Wochenschr 2006; 118:175-9. [PMID: 16773484 DOI: 10.1007/s00508-006-0566-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Accepted: 01/11/2006] [Indexed: 10/24/2022]
Abstract
Parathyroid carcinoma constitutes less than 1 % of primary hyperparathyroidism. The male to female ratio is approximately equal and the mean age at presentation is 40 years. In about half of the patients there is a palpable cervical mass, and serum calcium level is usually above 14 mg/dl. In a case report we present a 21-year-old man with a non-tender, non-mobile bulging mandibular mass. He suffered from fatigue, recent weight loss, hoarseness, polydipsia, polyuria, hematuria, recurrent renal stones and bouts of constipation and diarrhea. A mandibular biopsy confirmed brown tumor. Serum calcium level was 15.4 mg/dl. Cervical ultrasound revealed a hypoecho area suspicious of parathyroid adenoma. Parathyroid carcinoma was later confirmed and en bloc resection was performed. During a two-year follow up there has been no evidence of recurrence or hypercalcemia. This unique case of parathyroid carcinoma in conjunction with brown tumor is the second reported case worldwide.
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Affiliation(s)
- Payam S Pahlavan
- Department of Physiology and Pathophysiology, University of Heidelberg, Germany.
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van Baardwijk A, de Jong J, Arens A, Thimister P, Verseput G, Kremer B, Lambin P. False-positive FDG-PET scan due to brown tumours. Eur J Nucl Med Mol Imaging 2005; 33:393-4. [PMID: 16385408 DOI: 10.1007/s00259-005-1979-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 09/25/2005] [Indexed: 11/30/2022]
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