Brown tumor of the maxillary sinus in a patient with primary hyperparathyroidism: a case report

Journal of Medical Case Reports 07/2009; 3:7495. DOI: 10.4076/1752-1947-3-7495
Source: PubMed

ABSTRACT Brown tumors are rare focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. Brown tumors can affect the mandible, maxilla, clavicle, ribs, and pelvic bones. Therefore, diagnosis requires a systemic investigation for lesion differentiation.
We present a 42-year-old Greek woman, with a rare case of brown tumor of the maxillary sinus due to primary hyperparathyroidism. Primary hyperparathyroidism is caused by a solitary adenoma in 80% of cases and by glandular hyperplasia in 20%.
Differential diagnosis is important for the right treatment choice. It should exclude other giant cell lesions that affect the maxillae.


Available from: Chariton Papadakis, Apr 28, 2015
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    ABSTRACT: Brown tumour [BT] is an uncommon, non neoplastic complication of Hyperparathyroidism [HPT]. Skeletal changes are the main consequences of this endocrine condition. HPT manifest in three categories. Primary HPT is due to hyperfunction of one or more parathyroid gland, causing an increase of parathyroid hormone secretion resulting in hypercalcemia. Secondary HPT occurs due to chronic renal failure, decreased vitamin D production or with hypocalcemia. Tertiary HPT occurs when the parathyroid activity turns autonomous and excessive, leading to hypercalcemia. BT occurs frequently in the mandible than the maxilla. They are more common in women aged over 50y and majority of BT are asymptomatic. Radiographically, it appears as well defined radioluceny. The gross specimen usually shows a brown or reddish-brown colour. We report a relatively rare combination of maxillary posterior BT as a clinical manifestation of secondary HPT due to vitamin D deficiency with polydactyly, syndactyly and cardiac anomalies.
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    ABSTRACT: A case of 19-year-old male patient reported with the chief complaint of slowly growing diffuse painless swelling over the right part of the face from last 6 months. Intraoral examination revealed a swelling on right side of palate in relation to molar region with buccal cortical plate expansion. Radiographic examination (orthopantograph and 3DCT) showed large multilocular radiolucency in right maxilla with generalized loss of lamina dura. Incisional biopsy was done and specimen was sent for histopathological examination which showed multinucleated giant cells containing 15-30 nuclei. Based on clinical, radiological, and histopathological findings provisional diagnosis of central giant cell granuloma was made. Blood tests after histopathology demonstrated elevated serum calcium level and alkaline phosphatase level. Immunoassay of parathyroid hormone (PTH) level was found to be highly elevated. Radiographic examination of long bones like humerus and femur, mandible, and skull was also done which showed osteoclastic lesions. Considering the clinical, radiographic, histopathological, and blood investigation findings, final diagnosis of brown tumour of maxilla was made. The patient underwent partial parathyroidectomy under general anaesthesia to control primary hyperparathyroidism. Surgical removal of the bony lesion was done by curettage. The patient has been followed up for 1 year with no postoperative complications and the lesion healed uneventfully.
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    ABSTRACT: The authors present a case study of a 40-year-old man with advanced, previously undiag-nosed primary hyperparathyroidism (PHPT), which first manifestation directing to correct diagnosis was sellar-parasellar brown tumor. Further studies disclosed PHPT. The patient presented many of the classic signs of the dis-ease, including renal stones, duodenal ulcer, muscle weakness and bone pains, but suspi-cion of PHPT was made on the base of a post-operative histological examination of the sell-ar-parasellar tumor. Laboratory investigations showed hypercalcaemia, hypophosphataemia, elevated levels of parathyroid hormone and alkaline phosphatase. A skeletal survey showed generalized decreased density of bones and multiple brown tumors. The problems of diag-nosis and localization of parathyroid glands have been discussed. The literature has been reviewed and the importance of early diagnosis and treatment has been stressed.
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