Dental and Medical Problems

Dent Med Probl
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ISSN 1644-387X (print)
ISSN 2300-9020 (online)
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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

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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


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

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