Expansile lesion of the mandible in a 45-year-old woman

A complex case of brown tumors as initial manifestation of primary hyperparathyroidism in a young female

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.

A complex case of brown tumors as initial manifestation of primary hyperparathyroidism in a young female

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.

Brown Tumour in the Mandible and Skull Osteosclerosis Associated with Primary Hyperparathyroidism - A Case Report

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.

Brown tumour of the maxilla and mandible: a rare complication of tertiary hyperparathyroidism

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.