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Karaca MO, Özyıldıran M, Savran MD, Başarır K, Yıldız HY. Brown tumors: Retrospective analysis of 26 cases. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05372-9. [PMID: 38795187 DOI: 10.1007/s00402-024-05372-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/07/2024] [Indexed: 05/27/2024]
Abstract
INTRODUCTION Brown tumors are reactive osteolytic lesions caused by hyperparathyroidism. These rare lesions are non-neoplastic processes that result from bone resorption. The purpose of this study was to retrospectively review a 34-year experience with brown tumors in our institution. MATERIALS AND METHODS We retrospectively analyzed the records of 26 consecutive patients with brown tumor who were treated in our institution between May 1988 and October 2020, with a mean follow-up of 36,1 months. RESULTS 17 male (65,4%) and 9 female (34,6%) patients with a mean age of 41,6 were included in the study. Localized bone pain was present in 13 cases (50,0%) as the first presenting symptom. 3 patients (11,5%) presented with diffuse bone pain. 7 patients (26,9%) were diagnosed with brown tumor while being investigated for pathological fractures. The other 3 patients (11,5%) were diagnosed while being evaluated for hypercalcemia symptoms. 7 patients (26,9%) had solitary lesions, while 19 patients (73,1%) had multiple lesions. Pelvis, femur, ribs, tibia, proximal humerus and mandible were the most common sites of localization. 23 patients (88,5%) were diagnosed with primary hyperparathyroidism, while the other 3 patients (11,5%) had secondary hyperparathyroidism. A total of the 65 lesions, 23 (35.4%) underwent orthopedic surgery, and 42 (64.6%) were followed up conservatively after parathyroidectomy. Orthopedic surgery was performed in 21 of 26 patients, the other 5 cases were followed up conservatively. Intralesional curettage was performed in 19 cases (82,6%). The resulting cavity was filled with bone cement in 11 cases (47,8%). Bone grafting was applied in 8 cases (34,8%). No recurrence was observed in any of the patients. CONCLUSION The diagnosis of brown tumor begins with clinical suspicion. Endocrinology and general surgery consultation is important before surgery. Treatment of brown tumors requires a multidisciplinary approach.
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Affiliation(s)
- Mustafa Onur Karaca
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
| | - Mustafa Özyıldıran
- Department of Orthopedics and Traumatology, Sandıklı State Hospital, Afyonkarahisar, Turkey.
| | - Merve Dursun Savran
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
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Albagieh H, Alosimi A, Aldhuhayan A, AlAbdulkarim A, Fatani B, Alabood A. Dental management of patients with renal diseases or undergoing renal transplant. Saudi Dent J 2024; 36:270-276. [PMID: 38420005 PMCID: PMC10897630 DOI: 10.1016/j.sdentj.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The kidneys carry out many essential processes. A reduced glomerular filtration rate is the primary cause of renal failure. Patients with chronic kidney disease are significantly increasing all around the world. Patients with varying degrees of renal disease will be seen on the dental chair, and the dentist must be aware of dental considerations when treating such patient. Dental clinicians should carefully evaluate the oral findings and general condition of the renal disease patient. OBJECTIVE To increase the awareness of dentists in the dental management of patients with renal diseases or undergoing renal transplant. METHODS This study reviews 56 articles searched on two databases PubMed and Google Scholar with English language. CONCLUSION Every dentist should be well-informed regarding dental considerations and oral manifestations when treating a patient with any renal disease. Simple treatment plan modification can prevent the evolution of mild to critical medical or dental complications in renal disease patients.
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Affiliation(s)
- Hamad Albagieh
- Oral Medicine and Diagnostic Sciences Department, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Asim Alosimi
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Bader Fatani
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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3
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Fedhila M, Belkacem Chebil R, Marmouch H, Terchalla S, Ayachi S, Oueslati Y, Oualha L, Douki N, Khochtali H. Brown Tumors of the Jaws: A Retrospective Study. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231210143. [PMID: 37942058 PMCID: PMC10629299 DOI: 10.1177/11795514231210143] [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: 03/06/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
Objectives (1) Describe the clinical spectrum, imaging features, management, and outcome of brown tumors (BT) of the jaws. (2) Determine via a literature review the facts and controversies around the characteristics and management of this lesion. Materials and methods Our study was approved by the institutional committee of Sahloul University Hospital in accordance with the ethical standards of the Declaration of Helsinki. Sixteen patients with BT in the context of a primary, secondary, and tertiary hyperparathyroidism were treated and followed up during their recovery. Results This study reports 16 patients with a mean age of 48 years old. Brown tumor lesions were associated with primary hyperparathyroidism in 6 cases (38%), secondary hyperparathyroidism to chronic kidney failure in 5 cases (31%), and tertiary hyperparathyroidism in the context of a long lasting CRI in 5 cases. Their location was maxillary in 7 cases, mandibular in 5 cases, and bimaxillary in 4 cases. The treatment consisted of parathyroidectomy in 13 patients, maxillary resection in 3 cases, and vitamin D treatment in 2 cases. Favorable outcomes, characterized by tumor regression, were reported in 9 cases, whereas unfavorable evolution was observed among 7 patients. Conclusion Parathyroidectomy is the gold standard treatment for primary hyperparathyroidism. It resulted in a total regression in all our cases. Regarding secondary hyperparathyroidism, blood screening and chronic renal insufficiency follow-up are critically valuable to detect this condition at an early stage, hence increasing the success rate of brown tumor regression. Our secondary and tertiary hyperparathyroidism results were miscellaneous; although it is important to emphasize the importance of the chronic renal insufficiency management to ensure a success. Clinical relevance Brown tumors should be included in the differential diagnosis of giant cell lesions. Parathyroidectomy is usually sufficient to induce the total regression of the lesion in primary hyperparathyroidism cases. A more delicate approach is needed regarding secondary hyperparathyroidism. Meticulous control of chronic renal insufficiency is mandatory in addition to parathyroidectomy.
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Affiliation(s)
- Maya Fedhila
- Department of Oral Medicine and Oral Surgery, Sahloul Hospital (Sousse), Faculty of Dental Medicine of Monastir, University of Monastir, Monastir Tunisia
| | - Raouaa Belkacem Chebil
- Department of Oral Medicine and Oral Surgery, Sahloul Hospital (Sousse), Faculty of Dental Medicine of Monastir, University of Monastir, Monastir Tunisia
| | - Hela Marmouch
- Department of Endocrinology,Fattouma Bourguiba Hospital, Faculty of Medicine of Monastir, University of Monastir,Monastir, Tunisia
| | - Sabrine Terchalla
- Department of Oral Medicine and Oral Surgery, Sahloul Hospital (Sousse), Faculty of Dental Medicine of Monastir, University of Monastir, Monastir Tunisia
| | - Samia Ayachi
- Department of Maxillofacial Surgery, Sahloul Hospital (Sousse), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Yassine Oueslati
- Department of Oral Medicine and Oral Surgery, Sahloul Hospital (Sousse), Faculty of Dental Medicine of Monastir, University of Monastir, Monastir Tunisia
| | - Lamia Oualha
- Department of Oral Medicine and Oral Surgery, Sahloul Hospital (Sousse), Faculty of Dental Medicine of Monastir, University of Monastir, Monastir Tunisia
| | - Nabiha Douki
- Department of Conservative Dentistry, Sahloul Hospital (Sousse), Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Habib Khochtali
- Department of Maxillofacial Surgery, Sahloul Hospital (Sousse), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
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Muacevic A, Adler JR, Caridade S. Secondary Hyperparathyroidism Presenting as a Brown Tumor: A Case Report and Review of the Literature. Cureus 2023; 15:e33820. [PMID: 36819315 PMCID: PMC9930372 DOI: 10.7759/cureus.33820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/18/2023] Open
Abstract
Severe secondary hyperparathyroidism in advanced stages of chronic kidney disease (CKD) is associated with CKD-related mineral and bone disease (CKD-MBD). A 70-year-old woman was admitted at the Hospital for generalized bone pain and peripheral edema. Initial laboratory tests revealed normocytic anemia and severe renal dysfunction, and further tests evidenced severe secondary hyperparathyroidism. Full-body computerized tomography showed an osteolytic lesion in the right iliac wing. The iliac bone lesion was biopsied and histological examination was consistent with the diagnosis of a brown tumor of hyperparathyroidism. Brown tumors are a rare variant of osteitis fibrosa cystica that results from sustained high levels of parathyroid hormone in CKD. This case sheds light on rare complications that are experienced today in CKD. The clinical and biochemical setting, as well as the clinical suspicion, are essential to the diagnosis.
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Er N, Adiloğlu S, Acar G. An unusual case report: normocalcemic markers and their relationship with multiple sclerosis in primary hyperparathyroidism disease revealed by radiological markers with the diagnosis of brown tumor. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00714-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Brown tumor is a giant cell focal bone lesion associated with hyperparathyroidism and is more common in long bones such as the femur, ribs, pelvis, and clavicle, rather than in the head and neck region. Brown tumors occur less frequently in patients with primary hyperparathyroidism and are not usually a diagnostic marker of the disease. In addition, when primary hyperparathyroidism shows normocalcemic values and this disease is accompanied by multiple sclerosis, diagnosis becomes difficult.
Case presentation
A 57-year-old female patient presented with a painless, firm, irregularly circumscribed lesion extending from the upper palate to the nasal cavity. The lesion was first noticed by the patient about 2 months ago because it started to form asymmetry. The patient, whose anamnesis was learned to have Multiple Sclerosis (MS) and Chronic Obstructive Pulmonary Disease (COPD), was immobile. The patient was using medication only for COPD. After radiological and clinical examinations, the image in the maxilla was thought to be Brown Tumor and blood values were examined. After the incisional biopsy was also performed, it was evaluated together with the blood results and the diagnosis of brown tumor due to normocalcemic primary hyperparathyroidism was made. As in this case, brown tumor cases in which the calcium level remains within normal ranges, that is, due to Normocalcemic Hyperparathyroidism, are extremely rare, and 7 cases have been reported in the literature.
Conclusions
In the presented case, the importance of the radiological and clinical markers of the brown tumor developing due to normocalcemic hyperparathyroidism in the diagnosis is stated, the relationship of MS and the effects of the drugs used for MS at brown tumor formation is examined, and the importance of the treatment follow-up with radiological findings is stated. The features of the much rarer subgroups of relatively common diseases should be well known, and it should not be forgotten that the less frequently observed features can sometimes be the first indicator. And when large-limited lesions are identified, additional systemic features should be sought instead of direct surgical intervention.
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Pathological Fracture in Operation Room with Minimal Stress: an Extraordinary Case Report. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Li Cavoli G, Finazzo F, Mongiovi' R, Oliva B, Azzolina V, Li Cavoli TV. Cyst-like Tumors in Renal Osteodystrophy. Indian J Nephrol 2021; 31:595-596. [PMID: 35068773 PMCID: PMC8722559 DOI: 10.4103/ijn.ijn_204_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/20/2020] [Accepted: 10/11/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gioacchino Li Cavoli
- Department of Nephrology Dialysis Renal Transplantation, Civic Hospital, Palermo, Italy
| | | | - Rosalia Mongiovi'
- Department of Nephrology Dialysis Renal Transplantation, Civic Hospital, Palermo, Italy
| | - Barbara Oliva
- Department of Nephrology Dialysis Renal Transplantation, Civic Hospital, Palermo, Italy
| | - Vitalba Azzolina
- Department of Nephrology Dialysis Renal Transplantation, Civic Hospital, Palermo, Italy
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Massive Exophytic Brown's Tumor of the Bilateral Maxilla with Mandibular Involvement. J Craniofac Surg 2021; 33:897-900. [PMID: 34690307 DOI: 10.1097/scs.0000000000008308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Brown's tumor is a benign bone lesion that occurs in the setting of hyperparathyroidism and can affect the facial skeleton. It often presents as a single lesion and is usually less than 3 centimeters. To our knowledge, no cases have been reported to have bilateral involvement of the maxilla and mandible with the largest dimension measuring over 7 centimeters. This report describes such a case and provides a review of the literature.
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Ruddocks LA, Nascimento AF, Bhattacharyya I, Islam MN, Cohen DM. Central odontogenic fibroma in association with brown tumor of hyperparathyroidism in a patient with neurofibromatosis type 1. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:e26-e32. [PMID: 34511348 DOI: 10.1016/j.oooo.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/04/2021] [Indexed: 11/24/2022]
Abstract
We present a patient with bone abnormalities and a myriad of lesions secondary to his redeveloping renal failure and neurofibromatosis type 1 (NF1). A 21-year-old male renal transplant recipient with NF1 presented with painless masses and large, irregular radiolucent lesions in the maxilla and mandible. After histologic examination, the lesion was diagnosed as a central odontogenic fibroma (COdF) in association with a central giant cell lesion, most consistent with brown tumor of hyperparathyroidism. The bone changes were interpreted to be highly suggestive of renal osteodystrophy. Around 30 cases of hybrid central giant cell granuloma-like lesion in association with central odontogenic fibroma have been reported. This, to our knowledge, is the first reported case of brown tumor in association with COdF. Our case provides further evidence of the giant cell component as the initiating entity in these hybrid lesions.
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Affiliation(s)
- Lauren A Ruddocks
- Resident, Oral & Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA.
| | - Alessandra F Nascimento
- Unit Director, Bone & Soft Tissue Pathology, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Indraneel Bhattacharyya
- Division Director, Oral & Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed N Islam
- Program Director, Oral & Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Donald M Cohen
- Department Chair, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
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Shavlokhova V, Goeppert B, Gaida MM, Saravi B, Weichel F, Vollmer A, Vollmer M, Freudlsperger C, Mertens C, Hoffmann J. Mandibular Brown Tumor as a Result of Secondary Hyperparathyroidism: A Case Report with 5 Years Follow-Up and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147370. [PMID: 34299820 PMCID: PMC8304219 DOI: 10.3390/ijerph18147370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 12/02/2022]
Abstract
Background: Brown tumor is a rare skeletal manifestation of secondary hyperparathyroidism. Although diagnosis of the disease is increasingly seen in early stages due to improved screening techniques, some patients still present in a progressed disease stage. The treatment depends on tumor mass and varies from a conservative approach with supportive parathyroidectomy to extensive surgical resection with subsequent reconstruction. Case presentation: We report a case of extensive mandibular brown tumor in a patient with a history of systemic lupus erythematosus, chronic kidney disease, and secondary hyperparathyroidism. Following radical resection of the affected bone, reconstruction could be successfully performed using a free flap. Conclusions: There were no signs of recurrence during five years of close follow-up. Increased awareness and multidisciplinary follow-ups could allow early diagnosis and prevent the need for radical therapeutical approaches.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
- Correspondence:
| | - Benjamin Goeppert
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (B.G.); (M.M.G.)
| | - Matthias M. Gaida
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (B.G.); (M.M.G.)
- Institute of Pathology, University Medical Center Mainz, Johannes Gutenberg-Universität Mainz, 55131 Mainz, Germany
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany;
| | - Frederic Weichel
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Andreas Vollmer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Michael Vollmer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Christian Mertens
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Jürgen Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
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Growing gingival mass in a patient affected by hyperparathyroidism. J Am Dent Assoc 2021; 153:582-587. [PMID: 34090663 DOI: 10.1016/j.adaj.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/07/2021] [Accepted: 03/08/2021] [Indexed: 11/21/2022]
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12
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Aravindhan R, Magesh KT, Vivek N, Saravanan C. Maxillary brown tumor due to secondary hyperparathyroidism in a Hemodialysis patient: A case report and literature review. J Oral Maxillofac Pathol 2021; 25:527-532. [PMID: 35281174 PMCID: PMC8859602 DOI: 10.4103/jomfp.jomfp_157_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/07/2021] [Accepted: 09/05/2021] [Indexed: 11/08/2022] Open
Abstract
Hemodialysis is one of the commonly used renal replacement therapies in treating end-stage renal failure patients. Patients with long-term dialysis may develop frequently complications such as secondary hyperparathyroidism (SHPT), bone diseases, amyloidosis, endocrinal disturbances, cardiovascular complications and infections. Brown tumors (BTs) are erosive giant cell bony lesions that arise in some patients as a result of primary or SHPT. About 2% of all the reported cases showed involvement of facial skeleton, of which the mandible is the favorite site. A complete clinical, biochemical, radiological and histopathological correlation is required for definitive diagnosis. We report here a case of BT in 37-year-old female hemodialysis patient with SHPT.
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Abdala R, Gonzalez Pernas MS. Coexistence of brown tumors due to secondary hyperparathyroidism and prostate cancer in a patient. Osteoporos Int 2021; 32:205-208. [PMID: 32772143 DOI: 10.1007/s00198-020-05558-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
We present the case of a 65-year-old man with brown tumors due to secondary hyperparathyroidism. Magnetic resonance imaging of the pelvis showed multiple lesions with expansive bone appearance. Additionally, prostate cancer was diagnosed during this time. For this reason, differential diagnosis was performed through biopsy of the right iliac bone lesion. Brown tumors are caused by osteoclastic activity and fibroblast proliferation; the differential diagnosis of these bone lesions includes giant tumors, metastases, Paget's disease, and paraneoplastic syndrome with high levels of parathyroid hormone-related peptide (PTHrP). This case report describes the coexistence of two pathologies that could explain these images. In this report, we present a case of a 65-year-old man with brown tumors due to secondary hyperparathyroidism and prostate cancer. In this setting, histologic confirmation is recommended.
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Affiliation(s)
- Ruben Abdala
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Libertad 836, 1st Floor, 1012, Buenos Aires, Argentina
| | - Mariana S Gonzalez Pernas
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Libertad 836, 1st Floor, 1012, Buenos Aires, Argentina.
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Bransky N, Iyer NR, Cannon SM, Tyan AH, Mylavarapu P, Orosco R, Hom DB, Moazzam AA. Three Rare Concurrent Complications of Tertiary Hyperparathyroidism: Maxillary Brown Tumor, Uremic Leontiasis Ossea, and Hungry Bone Syndrome. J Bone Metab 2020; 27:217-226. [PMID: 32911586 PMCID: PMC7571245 DOI: 10.11005/jbm.2020.27.3.217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/02/2020] [Indexed: 12/27/2022] Open
Abstract
A 48-year-old woman in her 40’s with end-stage renal disease and tertiary hyperparathyroidism (HPT) presented for a rapidly progressive maxillary tumor. Initial workup was notable for elevated intact parathyroid hormone (PTH) and diffuse thickening of skull and facial bones on computed tomography, and maxillary tumor biopsy with multinucleated giant cells. She underwent subtotal parathyroidectomy (with removal of a parathyroid adenoma and 2 hyperplastic glands) and partial resection of maxillary brown tumor. The patient’s post-operative course was complicated by hungry bone syndrome, with hypocalcemia refractory to aggressive calcium repletion. Teriparatide (recombinant PTH) was utilized with rapid resolution of hypocalcemia. To our knowledge, this is the first case of maxillary brown tumor in tertiary HPT to be reported in the USA. This case also supports teriparatide as a novel therapeutic for hungry bone syndrome refractory to aggressive calcium repletion.
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Affiliation(s)
- Natalie Bransky
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - Neena Ramesh Iyer
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | | | | | - Praneet Mylavarapu
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - Ryan Orosco
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - David Brain Hom
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - Alan Ali Moazzam
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
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Lajolo C, Patini R, Limongelli L, Favia G, Tempesta A, Contaldo M, De Corso E, Giuliani M. Brown tumors of the oral cavity: presentation of 4 new cases and a systematic literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:575-584.e4. [PMID: 32192952 DOI: 10.1016/j.oooo.2020.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/12/2020] [Accepted: 02/01/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to obtain data from a review of cases of brown tumors (BT), which are benign lesions of bone characterized by giant cells that arise during hyperparathyroidism (HPTH). BTs may affect the maxillofacial area and manifest as a brownish, slow-growing swelling causing difficulty in the differential diagnosis. STUDY DESIGN We present data from 4 new cases of oral BTs based on a systematic literature review conducted by searching EMBASE, Medline, and CENTRAL databases, according to the PRISMA guidelines. Only articles in English were considered. Individual patient data were analyzed to identify risk factors for multiple or extraoral maxillofacial BTs. RESULTS In total, 167 cases (163 from 136 articles and 4 new cases; mean age 36.6 years; male-to-female ratio 1:2) were retrieved. The onset of extraoral maxillofacial BTs (odds ratio [OR] 176.3; 95% confidence interval [CI] 18.7-1657.8; P < .05) and maxillary BTs (OR 17.5; 95% CI 6.0-50.8; P < .05) were the risk factors for multiple oral BTs, whereas the presence of a BT in the mandible (OR 0.01; 95% CI 0.001-0.1; P < .05) was a negative predictor for the presence of other extraoral maxillofacial BTs. CONCLUSIONS The results of this systematic review suggested that the mandible is the most frequent oral location of BTs. Whenever a BT is detected in the maxilla or when multiple oral BTs are diagnosed, more BTs in the maxillofacial area should be suspected.
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Affiliation(s)
- Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Romeo Patini
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Luisa Limongelli
- Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, "Aldo Moro" University, Bari, Italy
| | - Gianfranco Favia
- Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, "Aldo Moro" University, Bari, Italy
| | - Angela Tempesta
- Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, "Aldo Moro" University, Bari, Italy
| | - Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania L. Vanvitelli, Naples, Italy
| | - Eugenio De Corso
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Giuliani
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Alwani MM, Monaco GN, Harmon SM, Nwosu OI, Vortmeyer AO, Payner TD, Ting J. A Systematic Review of Sellar and Parasellar Brown Tumors: An Analysis of Clinical, Diagnostic, and Management Profiles. World Neurosurg 2019; 132:e423-e429. [PMID: 31470158 DOI: 10.1016/j.wneu.2019.08.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/17/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To systematically review and analyze clinical, diagnostic, and management trends in sellar and parasellar brown tumors reported in existing literature. METHODS In this systematic review, PubMed, Ovid MEDLINE, Scopus, and Google Scholar databases were searched for reported cases of sellar/parasellar brown tumors. Relevant titles and abstracts were screened in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Articles meeting inclusion criteria were subjected to data extraction, summarization, and analysis. A rare case of parasellar brown tumor was also presented. RESULTS Eight reports (including the current report) were eligible for inclusion. Mean patient age was 42.75 years. Reported symptoms included visual disturbances (n = 6), headache (n = 5), fatigue (n = 3), nausea/vomiting (n = 2), chest pain (n = 1), neck pain (n = 1), and dysphagia (n = 1). In cases where computed tomography findings were provided (n = 6), lesions were noted to be expansile and lytic. Lesions were hyperintense on T2-weighted magnetic resonance imaging (66.7%) and demonstrated contrast enhancement (83.3%). Histology unanimously showed multinucleated giant cells in a fibrovascular connective tissue stroma. Dramatic symptom resolution was noted in all patients who underwent resection of the sellar/parasellar brown tumor (n = 4; 50%). CONCLUSIONS Sellar/parasellar brown tumors are a rare, tertiary manifestation of hyperparathyroidism and can be elusive to diagnose. Diagnosis requires a high index of clinical suspicion in addition to comprehensive biochemical testing, imaging, and histopathologic analysis. Surgical extirpation is favored in cases where the lesion is causing compressive symptoms, or if it is unresponsive to management of hyperparathyroidism.
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Affiliation(s)
- Mohamedkazim M Alwani
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | - Gina N Monaco
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sydney M Harmon
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Obi I Nwosu
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexander O Vortmeyer
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Troy D Payner
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA; Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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17
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The Use of Virtual Surgical-Guided Osteoplasty for Maxillofacial Brown Tumors. J Craniofac Surg 2019; 30:e551-e553. [PMID: 30939562 DOI: 10.1097/scs.0000000000005507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 28-year-old African American female with end-stage renal disease on dialysis secondary to preeclampsia presented to the office as a referral for large multifocal tumors of maxilla and mandible. Surgical pathology and laboratory findings were supportive of secondary hyperparathyroidism leading to multifocal brown tumors. She underwent osteoplasty after using virtual surgical planning to create stereolithic models to visualize the tumor and fabricate cutting guides to minimize the risk of injury to adjacent nerves and teeth. Brown tumors can be resistant to medical management with unreliable regression in size. With the advent of customized surgical guides, more precise and judicious surgery can be performed on these types of tumors safely.
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Hu J, He S, Yang J, Ye C, Yang X, Xiao J. Management of brown tumor of spine with primary hyperparathyroidism: A case report and literature review. Medicine (Baltimore) 2019; 98:e15007. [PMID: 30946329 PMCID: PMC6456137 DOI: 10.1097/md.0000000000015007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Brown tumor (BT) is a rare benign lesion in skeletal system. It is especially rare secondary to primary hyperparathyroidism (HPT). The differential diagnosis can be misleading due to its diversified clinical characteristics. Final diagnosis mainly relies on excessive elevated parathyroid hormone and biopsy. Treatments include surgical interventions and drugs. Only 19 articles (total 22 cases) reported BT of spine caused by primary HPT. PATIENT CONCERNS A 50-year-old woman was admitted to our hospital complaining left elbow and thoracodorsal pain with the lower limbs weakness. DIAGNOSES Multifocal BT. INTERVENTIONS The patient received intramuscular injection of Miacalcic and incense of Calcitonin (Salmon) Nasal Spray to decrease serum calcium level. Surgery was performed later to excise the ectopia parathyroidoma. OUTCOMES At 1-year follow-up, the patient was able to lead an independent life in her full capacity, even though she occasionally complained mild weakness of lower limbs. LESSONS BT of spine with HPT is rarely seen in the clinical practice. Treating the primary parathyroid diseases can be effective. For patients with vertebral fractures and neural deficits, immediately surgical intervention will be necessary to prevent the worse of neurological function.
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Lin B, Liu Y, He Q. Misdiagnosed as osteosarcoma: Brown tumour in a haemodialysis patient. Nephrology (Carlton) 2018; 23:190-192. [PMID: 29346843 DOI: 10.1111/nep.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Bo Lin
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yueming Liu
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Qiang He
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, China
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