Mandibular Brown Tumor of Secondary Hyperparathyroidism Requiring Extensive Resection: A Forgotten Entity in the Developed World?

Mohammed Qaisi,Ron Caloss,Matthew Loeb,Lindsay Montague

doi:10.1155/2015/567543

Abstract

Brown tumor of hyperparathyroidism (BTHPT) is rare in the United States and not frequently seen in clinical practice. This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT. Conversely, BTHPT is more common in underdeveloped countries where fewer patients have access to health care and hyperparathyroidism (HPT) goes untreated. It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT. We present a case report of a patient in the United States with a large mandibular BTHPT requiring an extensive resection in the setting of secondary HPT. Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.

Highlights

In a healthy individual, the parathyroid glands and kidneys play an important role in the homeostasis and regulation of serum calcium (Ca) and phosphorus (P) levels
Parathyroid hormone (PTH) is released in response to decreased serum Ca and functions to increase this by causing an efflux of Ca from the bony skeleton and increased reabsorption by the kidneys
Hyperparathyroidism (HPT) is a disorder characterized by an excessive amount of parathyroid hormone secretion by the parathyroid glands

Summary

Introduction

The parathyroid glands and kidneys play an important role in the homeostasis and regulation of serum calcium (Ca) and phosphorus (P) levels. When any of these forms of HPT are not well controlled, BTHPT may result These nonneoplastic lesions present late in untreated disease and are more commonly seen in underdeveloped countries due to the lack of access to care; they are infrequently seen in developed countries [6]. These lesions appear identical to central reparative giant cell granulomas histologically and result because of the abnormal calcium homeostasis in HPT [2]. Surgical treatment may be required in refractory cases or in large symptomatic lesions [7]

Case Report

Findings

Discussion

Conclusion