Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2020) – 128.41
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI – 0.5
Average rejection rate (2021) – 81.35%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download PDF

Dental and Medical Problems

2017, vol. 54, nr 4, October-December, p. 429–434

doi: 10.17219/dmp/80300

Publication type: clinical case

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

Multifocal brown tumor of the maxilla and mandible in primary hyperparathyroidism – diagnostic challenges and literature review

Wieloogniskowy guz brunatny kości szczęki i żuchwy w przebiegu pierwotnej nadczynności przytarczyc (PNP) – trudności diagnostyczne i przegląd piśmiennictwa

Bartosz Gogolewski1,B,D,E,F, Magdalena Jędrusik-Pawłowska1,A,C,D,E,F, Bogna Drozdzowska2,C,D,F

1 Department of Maxillofacial Surgery, The St. Barbara Provincial Specialist Hospital No 5 – Trauma Center, Sosnowiec, Poland

2 Department of Pathology, School of Medicine with the Division of Dentistry, Medical University of Silesia, Zabrze, Poland

Abstract

Multifocal brown tumors are a rare complication of primary hyperparathyroidism (PHPT). The reported prevalence of PHPT-related brown tumor is 3–4%. The tumor may histologically resemble any giant cell tumor of the jaws; hence, diagnostic errors or a delayed diagnosis of PHPT, when the lesion is the first clinical manifestation of this disease. We present a 27-year-old patient at 17-week gestation, who was diagnosed with an expansile mass in the left maxilla. Diagnostic tests also revealed two osteolytic lesions in the mandible. The patient underwent left maxillary segmental resection; the tumor was resected en bloc with teeth 25, 26. Histology confirmed the primary diagnosis of giant cell tumor. The observation was continued on an outpatient basis. Following delivery, progression of mandibular osteolytic lesions and maxillary tumor recurrence were found. Blood chemistry panel was ordered and the results raised a suspicion of primary hyperparathyroidism. Subsequent diagnostic tests revealed lower right parathyroid adenoma. Parathyroidectomy resulted in an almost complete regression of the mandibular lesions and a slight regression of the maxillary tumor. The paper presents diagnostic challenges associated with brown tumors as well as clinical, radiological, biochemical and histological manifestations thereof. The effect of pregnancy on the course of primary hyperparathyroidism is discussed and a diagnostic/therapeutic scheme is proposed when giant cells are present in a biopsy specimen.

Key words

primary hyperparathyroidism, brown tumor of the maxilla/mandible, giant cell tumor of the maxilla/mandible, pregnancy epulides

Słowa kluczowe

pierwotna nadczynność przytarczyc, guz brunatny szczęki i żuchwy, guz olbrzymiokomórkowy szczęki i żuchwy, guzy ciążowe

References (21)

  1. Pawlak W, Bolanowski M, Bohdanowicz-Pawlak A, et al. Giant cell tumor of the mandible as the first manifestation of primary hyperparathyroidism: Case report. Dent Med Probl. 2005;42:517–520 [in Polish].
  2. Karwacka I, Lewandowska M, Obłończyk Ł, et al. PHP – primary hyperparathyroidism – permanently hidden pathology: A drama in four acts. Forum Med Rodz. 2012;6:161–167 [in Polish].
  3. Drozdzowska B, Gabriel A. Diagnostyka patomorfologiczna chorób przytarczyc. In: Gawrychowski J, Jarząb B. Choroby tarczycy i przytarczyc. Diagnostyka i leczenie. 1st ed., Warszawa: Medipage; 2014:260–268.
  4. Kalapala L, Keerthi Sai S, Babburi S, et al. An endocrine jaw lesion: Dentist perspective in diagnosis. Case Rep Dent. 2016; 2016:2582038. doi:10.1155/2016/2582038.
  5. Śliwa K, Marciniak M, Obłończyk Ł, et al. Epidemiology of primary hyperparathyroidism in people aged 55 and over. Probl Hig Epidemiol. 2010;91:248–255 [in Polish].
  6. Pietkiewicz M, Nienartowicz E, Sokołowska-Dąbek D, et al. Hyperparathyroidism: Molecular, diagnostic and therapeutic aspects. Postepy Hig Med Dosw (online). 2010;64:555–567.
  7. Kim HS, Choi BH, Park JR, et al. Delayed surgery for parathyroid adenoma misdiagnosed as a thyroid nodule and treated with radiofrequency ablation. Endocrinol Metab (Seoul). 2013;28:231–235.
  8. 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.
  9. Shetty AD, Namitha J, James L. Brown tumor of mandible in association with primary hyperparathyroidism: A case report. J Int Oral Health. 2015;7:50–52.
  10. Hakeem AH, Hakeem IH, Wani FJ. Upper alveolar brown tumor as initial presentation of parathyroid adenoma. Natl J Maxillofac Surg. 2015;6:229–231.
  11. Pawlak W, Bohdanowicz-Pawlak A, Bolanowski M, et al. Primary hyperparathyroidism presenting as giant cell tumor of the jaws. Neuroendocrinol Lett. 2013;34:107–110.
  12. Soundarya N, Sharada P, Prakash N, Pradeep G. Bilateral maxillary brown tumors in a patient with primary hyperparathyroidism: Report of a rare entity and review of literature. J Oral Maxillofac Pathol. 2011;15:56–59.
  13. Robinson RA, Vincent SD. Tumors and Cysts of the Jaws. 16th ed. Maryland: Silver Spring; 2012.
  14. Casteràs A, Darder L, Zafon C, et al. Brown tumor of the jaw after pregnancy and lactation in a MEN1 patient. Endocrinol Diab Metab Case Rep. 2016;2016:160111.
  15. Krysiak R, Bartecka A, Okopień B. Rare abnormalities of parathyroid gland function and parathyroid hormone receptor action. Przegl Lek. 2014;71:36–47 [in Polish].
  16. Chamarthi B, Greene MF, Dluhy RG. A problem in gestation. N Engl J Med. 2011;365:843–848.
  17. Ullah E, Ahmad M, Ali SA, Redhu N. Primary hyperparathyroidism having multiple brown tumors mimicking malignancy. Indian J Endocrinol Metab. 2012;16:1040–1042.
  18. Gellert R. Hypo- and hypercalcemia – pathogenesis and treatment dillema. Forum Nefrol. 2011;4:373–383 [in Polish].
  19. Dytfeld J, Horst-Sikorska W. Pregnancy, lactation and bone mineral density. Ginekol Pol. 2010;81:926–928.
  20. Arunkumar KV, Kumar S, Deepa D. Brown tumor in mandible as a first sign of vitamin D deficiency: A rare case report and review. Indian J Endocrinol Metab. 2012;16:310–315.
  21. Ennazk L, El Mghari G, El Ansari N. Jaw tumor in primary hyperparathyroidism is not always a brown tumor. Clin Cases Miner Bone Metab. 2016;13:64–66.