Brown Tumor Of Hyperparathyroidism Research Articles

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

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.

USP6 gene rearrangements occur preferentially in giant cell reparative granulomas of the hands and feet but not in gnathic location.

Giant cell reparative granulomas (GCRGs) are lytic lesions that occur predominantly in the gnathic bones and occasionally in the small bones of the hands and feet. They are morphologically indistinguishable from, and are regarded as synonymous with, solid variant of aneurysmal bone cysts (ABC) in extragnathic sites. Identification of USP6 gene rearrangements in primary ABC has made possible investigating potential pathogenetic relationships with other morphologic mimics. USP6 gene alterations in giant cell-rich lesions (GCRG/ABC) of small bones of the hands and feet have not been previously studied. We investigated USP6 gene alterations in a group of 9 giant cell-rich lesions of the hands and feet and compared the findings with morphologically similar lesions including 8 gnathic GCRGs, 22 primary ABCs, 8 giant cell tumors of bone, and 2 brown tumors of hyperparathyroidism. Overall, there were 49 samples from 48 patients including 26 females and 22 males. Of the 9 lesions of the hands and feet, 8 (89%) showed USP6 gene rearrangements, whereas no abnormalities were identified in the 8 gnathic GCRGs, 2 brown tumors, or 8 giant cell tumors of bone. Of the 22 primary ABCs, 13 (59%) showed USP6 gene rearrangements. In conclusion, most GCRGs of the hands and feet represent true ABCs and should be classified as such. The terminology of GCRG should be limited to lesions from gnathic location. Fluorescence in situ hybridization for USP6 break-apart is a useful ancillary tool in the diagnosis of primary ABCs and distinguishing them from GCRGs and other morphologically similar lesions.

Brown Tumor of Hyperparathyroidism: Case Report

Brown tumor related to hyperparathyroidism rarely affects facial bones. The oral radiographic manifestations of brown tumor of hyperparathyroidism (BTH) include root resorption and loss of lamina dura. Woman, 39, had swelling of the mandible extending from tooth #43 to #45, leathery consistency, and mobility of the involved teeth. A well-defined radiolucent area, the presence of the lamina dura, and root resorption were found. An incisional biopsy revealed giant cell lesion. It was decided not to explore the mandibular lesion surgically. Blood biochemistry analysis revealed increased parathormone level. The patient was referred for a surgical procedure to remove the parathyroid adenoma. Follow-up at 24 months showed hormonal regulation and regression of the BTH. The treatment in this case was conservative and the lamina dura was not lost. Clinicians should be aware that this unusual finding indicates a rare manifestation of BTH. Acknowledgment: FAPEMIG.

Brown Tumor of Hyperparathyroidism in The Mandible

Brown tumor is an erosive bone lesion that affects patients with hyperparathyroidism. It is caused by osteoclastic activity and peritrabecular fibrosis. Woman, 50, arrived at the UNIPÊ Dental Care Unit stating that she had had chronic kidney disease for 6 years. Physical examination noted asymmetry on the left lower third of the face. Panoramic radiography revealed a circumscribed multilocular radiolucent lesion in the posterior jaw region. An incisional biopsy was taken, and blood tests were requested. Examinations showed high levels of the parathyroid hormones, hypocalcemia, and hyperphosphatemia. Histologically, there were numerous multinucleate giant cells among dense connective tissue with hemorrhage and hemosiderin deposits. The lesion was diagnosed as brown tumor associated with secondary hyperparathyroidism. The patient was sent to a medical team for treatment of hyperparathyroidism and is under periodic observation.

Multicentric Giant Cell Tumor: Metachronous Central and Peripheral Involvement

Giant cell tumors are rare in the head and neck region. The most frequently involved sites of giant cell lesions in the head and neck are the maxilla and mandible, whereas the sphenoid and temporal bones are rarely involved. This tumor is usually located in the long bones of limbs. Reparative granuloma and brown tumor of hyperparathyroidism must be included in the differential diagnosis. Here we report the clinical and radiologic findings of a multicentric giant cell tumor with skull base involvement in a female patient. This case report demonstrates the similar pathophysiology of peripheral and central giant cell tumors.

Secondary hyperparathyroidism associated with multiple brown tumor: a case report

Brown tumour represents a serious complication of hyperparathyroidism. Definitive diagnosis is based on histological examination, clinical, radiological and laboratory data. Here we report a case of multiple brown tumours localised in collarbone, rib and in the distal ulna due to secondary hyperparathyroidism in a 37-year-old women with chronic renal failure. The clinical management of brown tumour aimed primarily to reduce the elevated parathyroid hormone levels by pharmacological treatment. In our experience, clinicians usually consider brown tumor of hyperparathyroidism is caused by giant cell lesions in maintenance hemodialysis recipients, and multiple brown tumours are rarely seen in these patients.

Central Giant Cell Lesion

A classic case of central giant cell lesion (CGCL) is presented with emphasis on clinical, radiologic, and histologic features. The differential is discussed including peripheral giant cell granuloma, brown tumor of hyperparathyroidism, and giant cell tumor of bone. The molecular pathway of osteoclastogenesis is selectively reviewed and applied to suggest possible etiologies of the giant cell lesions. CGCL syndromes and treatment are also discussed.

Maxillary brown tumour: unusual presentation of parathyroid carcinoma

AbstractThis is a report of a maxillary brown tumour caused by primary hyperparathyroidism (HPT) secondary to parathyroid carcinoma. A 62-year-old man presented with a large swelling in the right maxilla, which caused right-sided nasal obstruction, intermittent bleeding and diplopia. A computed tomography scan demonstrated an expansible, destructive soft tissue mass centred on the right ethmoid sinus, extending from the maxilla to the orbital floor. Histology showed a central giant cell granuloma of bone, thought to be a brown tumour of HPT and this was supported by serum calcium of 3.0 mmol/l and serum parathyroid hormone of 880 ng/l (normal 7 to 40 ng/l). Parathyroid imaging was consistent with a left lower parathyroid adenoma. The patient underwent removal of the parathyroid gland, left hemithyroidectomy and central node dissection. Histology confirmed parathyroid carcinoma. Surgical removal of the brown tumour was offered but declined. The symptoms improved and the maxillary swelling gradually reduced...

Increased expression of NFATc1 in giant cell lesions of the jaws, cherubism and brown tumor of hyperparathyroidism

A variety of diseases of the jaws may present multinucleated giant cells. These diseases include central giant cell lesions (CGCL), peripheral giant cell lesions (PGCL), brown tumor of hyperparathyroidism (BTH), and cherubism. The multinucleated giant cells in these lesions are osteoclast-like. Since NFATc1 plays a significant role in osteoclast differentiation, the present study aimed to compare the expression of NFATc1 in CGCL, PGCL, BTH and cherubism. A total of 14 formalin-fixed and paraffin-embedded tissue samples of CGCL (n=4), PGCL (n=5), BTH (n=3) and cherubism (n=2) were included in the study. An immunohistochemical analysis was performed to investigate the NFATc1 protein. The majority of giant cells in all of the cases were positive for nuclear NFATc1 and the immunostaining pattern was similar in all of the groups. Although our study supports the hypothesis that giant cell accumulation in PGCL, CGCL, BTH and cherubism is mediated by NFATc1, functional studies are required to investigate this hypothesis.

Bumps on the head: Brown tumors of hyperparathyroidism

Bumps on the head: Brown tumors of hyperparathyroidism

Brown Tumor of Hyperparathyroidism Masquerading as Central Giant Cell Granuloma in a Renal Transplant Recipient: A Case Report

The brown tumor of hyperparathyroidism is histologically identical to the central giant cell granuloma (CGCG), but these lesions can be differentiated based on history and laboratory findings. Herein we have reported a 46-year-old renal transplant recipient in whom brown tumors of hyperparathyroidism were detected several years following renal transplantation. The lesions initially masqueraded as a CGCG with an intranasal mass and ethmoid bone involvement at 7-years posttransplantation, for which surgical resection had been performed. Six years later, she developed multiple expansile bony lesions of the chest wall with histologic features of multinucleated giant cells. A markedly elevated parathyroid hormone level led us to make a diagnosis of brown tumor of hyperparathyroidism. Hence, we propose that clinicians consider brown tumor of hyperparathyroidism to be a potential cause of giant cell lesions among renal transplant recipients. Moreover, careful follow-up examinations are required for such patients to make a timely and accurate diagnosis.

Brown tumour of hyperparathyroidism: a surgical dilemma

Brown tumour of hyperparathyroidism: a surgical dilemma

Aspectos radiológicos e epidemiológicos do granuloma central de células gigantes

OBJETIVO: Este estudo teve como objetivo avaliar os principais aspectos radiográficos e epidemiológicos das lesões de células gigantes (granulomas centrais de células gigantes e tumores marrons do hiperparatireoidismo). MATERIAIS E MÉTODOS: A amostra consistiu de 26 lesões de células gigantes diagnosticadas em 22 pacientes divididos em dois grupos, um deles composto por 17 pacientes que não tinham hiperparatireoidismo (grupo A) e o outro formado por cinco pacientes portadores de tal distúrbio (grupo B). RESULTADOS: O sexo feminino (72,7%) foi o mais acometido. As lesões ocorreram mais freqüentemente na segunda década de vida, com média de idade de 27 anos. A mandíbula (61,5%) foi o arco mais envolvido. Radiograficamente, 57,7% das lesões eram multiloculares e 42,3% eram uniloculares com limites definidos. Todas as 26 lesões provocaram expansão óssea, 15,4% produziram reabsorção radicular, 50% causaram deslocamento dentário e 11,5% produziram dor. Na mandíbula, 18,7% das lesões cruzavam a linha média. O grupo A apresentou 66,7% das lesões na mandíbula e o grupo B mostrou igualdade na distribuição das lesões entre os arcos. O grupo A apresentou 66,7% das lesões multiloculares e 33,3%, uniloculares. O grupo B apresentou 62,5% das lesões uniloculares e 37,5%, multiloculares. CONCLUSÃO: As lesões de células gigantes podem manifestar-se, radiograficamente, com um amplo espectro, desde pequenas lesões uniloculares de crescimento lento até extensas lesões multiloculares. Elas apresentam características de benignidade, embora algumas lesões possam demonstrar um comportamento localmente agressivo.

Traumatic Bone Cyst of the Condylar Region: Report of 2 Cases

The traumatic bone cyst (TBC) has been a recognized entity since 1929, when it was described by Lucas, and subsequently further defined by Rushton. Although “traumatic bone cyst” may misrepresent the nature of the lesion, authors have noted the popularity of this label. This intraosseous entity is also known by a variety of synonyms including solitary bone cyst, simple bone cyst, hemorrhagic bone cyst, unicameral cyst, idiopathic bone cavity, and progressive bone cyst or cavity. Because the classical scalloped radiographic appearance is not diagnostic, nor does the lesion possess clinical specificity, it is important to differentiate it from other forms of pathology occurring in the maxillofacial region, including aneurysmal bone cyst, eosinophilic granuloma, central giant cell granuloma, ameloblastoma, brown tumor of hyperparathyroidism, and osteosarcoma. Most commonly, the TBC involves the body or symphysis of the mandible. It is rarely found in the condyle, with approximately 10 cases currently available. This report describes 2 new cases of TBC in the region of the mandibular condyle.

Cytologic aspect of brown tumor of hyperparathyroidism. Report of a case affecting the hard palate

The cytologic and histologic findings of one brown tumor (BT) of hyperparathyroidism located in the hard palate, at first misdiagnosed as peripheral giant-cell granuloma, are described. Poor communication between cytopathologist and ear nose and throat specialist was responsible for the error. The overriding cytologic finding was the presence of numerous multinucleated giant cells (MGCs) of the osteoclastic type. MGC-rich aspirates pose the same diagnostic dilemmas as those of histologic sections of MGC-containing lesions of bone: these cells are not diagnostic by themselves and can be seen in several benign and malignant conditions. Clinical history, X-ray films and biochemical findings, particularly serum parathormone levels, are essential to diagnose a BT and to rule out other MGC-rich bone lesions.

Pediatric giant cell granuloma of the temporal bone: a case report and brief review of the literature

Giant cell granuloma of the skull base is a distinct rare clinicopathologic lesion, which progressively destroys the involved bone. It causes increased intracranial pressure and mass effect on the brain. Histologically it may mimic an aneurysmal bone cyst, giant cell tumour and the brown tumour of hyperparathyroidism. Although cited by some authors, the role of trauma in its aetiology is still considered controversial. Authors present an interesting case of a 12 year old Omani boy who sustained a cricket bat injury to his right temporal region from which he initially recovered but later on progressively developed vertigo, tinnitus, right hearing loss and a mild right facial weakness. Computed tomography (CT scan) and Magnetic resonance imaging (MR scan) revealed a large destructive lesion of the temporal bone. Microsurgical excision was curative. Interesting clinicoradiological findings are presented with a brief review of the literature.

Cysts and cystic lesions of the mandible: clinical and radiologic-histopathologic review.

Many lesions that occur in the mandible have a cystlike radiographic appearance. These lesions are often difficult to differentiate on the basis of their radiographic features alone. Mandibular lesions may be odontogenic or nonodontogenic. Among odontogenic lesions without mineralization, ameloblastomas, odontogenic keratocysts, and dentigerous cysts can all appear as well-defined, unilocular, well-corticated, lucent lesions that are often associated with the crowns of impacted or unerupted teeth. Most radicular cysts appear as round or pear-shaped, unilocular, lucent lesions in the periapical region. Among odontogenic lesions with mineralization, complex odontomas contain multiple masses of dental tissue and compound odontomas contain multiple teeth or toothlike structures. Odontogenic myxomas are characterized by lytic osseous changes of varying size, which may be demarcated and expansile or exhibit ill-defined borders. Nonodontogenic lesions that mimic odontogenic lesions include benign fibro-osseous lesions (conventional or juvenile ossifying fibroma, focal or periapical cemento-osseous dysplasia, florid osseous dysplasia), traumatic bone cyst, lingual salivary gland inclusion defect, central giant cell granuloma, brown tumor of hyperparathyroidism, arteriovenous malformation, and mucoepidermoid carcinoma. The clinical and radiographic features of these mandibular lesions help establish a differential diagnosis, although microscopic tissue evaluation is generally necessary to accurately identify the lesion.

Giant Cell Tumor of the Sphenoid Bone

Giant cell tumor of the sphenoid bone is extremely unusual. This tumor is usually located in long bones and is rarely located in the cranial vault. It must be differentiated from reparative granuloma and the Brown tumor of hyperparathyroidism. This case report is only the second involving a patient in the first decade. A 9-year-old girl presented with cephalgia and diplopia. Radiographic imaging revealed an erosive mass in the clivus. The patient underwent an extended transphenoidal resection of the clivus. This was followed with 57.6 CGE in 32 fractionated doses. At 1 year follow-up, the tumor remains stable. Based on anecdotal evidence, attempted resection with adjuvant radiation therapy allows for long-term survival in these patients.

Recurring oral giant cell lesion in a child with X-linked hypophosphatemic rickets: Clinical manifestation of occult parathyroidism?

A 9-year-old boy with X-linked hypophosphatemic rickets had a recurring oral giant cell lesion. These lesions are relatively uncommon in children and represent a potentially aggressive disorder that is microscopically indistinguishable from the brown tumors of hyperparathyroidism. Subclinical hyperparathyroidism is not uncommon in X-linked hypophosphatemic rickets and may account for the giant cell lesion in this patient. (J P EDIATR 1995;127:444-6)

TI-201 Uptake in Brown Tumors of Hyperparathyroidism

Tl-201 chloride bone scans were performed on nine patients with primary hyperparathyroidism just after Tl-201 and Tc-99m parathyroid subtraction scintigraphy. Bone lesions accumulate Tl-201, especially in sites of brown tumor formation. This was proven by the histopathologic examination of two patients. Eight patients had bone scans with Tc-99m MDP. The lesion-to-background ratio was quantified in seven patients for Tl-201 and in four patients for Tc-99m MDP. Tl-201 uptake of the lesions were quantified in two patients. The lesion-to-background ratio was 1.63 +/- 0.21 and 2.51 +/- 0.88 for Tl-201 and Tc-99m MDP, respectively. A Ga-67 citrate scan was performed on one patient, and the lesion-to-background ratio was 1.49 +/- 0.06. The accumulation of Tl-201 in brown tumors of bone might be due to increased blood flow and local metabolic activity. Tl-201 chloride was inferior to Tc-99m MDP in lesion detection. It is concluded that bone imaging with Tl-201 can easily be performed following parathyroid subtraction scintigraphy to delineate the sites of brown tumor formation.