Brown tumor of the mandible - a possible clinical manifestation of primary hyperparathyreoidism

Abstract

Introduction. One of possible manifestations of primary hyperparathyroidism (PHPT) is the appearance of a benign bone tumor. We hereby present a case of a young woman whose first clinical manifestation of PHPT was a brown tumor of the mandible. Case report. A female patient was hospitalized in the Clinic of Endocrinology, Diabetes and Metabolic Disease due to the problems occurring in the form of nausea, exhaustion, feeling of suffocation, dysphagia, pain in the right ear and the right half of the cheeks, who was under suspicion of primary hyperparathyroidism (PHPT). Initial laboratory findings pointed out the high levels of parathyroid hormone (PTH) and Ca2+ ions, low levels of vitamin D and increased parameters of bone metabolism with signs of osteopenia. Cone beam computed tomography (CBCT) revealed a presence of bilateral radiolucent lesions of the mandible. Scintigraphy showed a retrosternal hot focus consistent with parathyroid adenoma. Parathyroidectomy was performed with following normalization of PTH values, bone metabolism parameters, and normalization of the Ca2+ ion values. Four months after parathyroidectomy, there was a complete resolution of clinical and radiological findings of initial tumefaction of the mandible. Conclusion. Brown tumors are rare first clinical manifestation of PHPT. Because of their histological similarities with other giant-cell lesions (GCL), definitive diagnosis is sometimes difficult, and is based on correlation with radiological and laboratory findings. Due to spontaneous regression of bone lesions after treatment of the basic cause of PHPT, brown tumors should be considered in the differential diagnosis of any giant-cell tumor lesions in order to avoid unnecessary surgical procedure.