Indian Journal of Endocrine Surgery and Research

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VOLUME 18 , ISSUE 2 ( July-December, 2023 ) > List of Articles


Clinical Enigma of Maxillofacial Tumors: Hyperparathyroidism-related Brown Tumors

Pratiksha Pant, Rizhin Sooraj, Ganesh Bhat, Pooja Ramakant

Keywords : Brown tumors, Case report, Giant cell tumors, Jaw swelling, Maxillofacial lesion, Primary hyperparathyroidism

Citation Information : Pant P, Sooraj R, Bhat G, Ramakant P. Clinical Enigma of Maxillofacial Tumors: Hyperparathyroidism-related Brown Tumors. 2023; 18 (2):79-82.

DOI: 10.5005/jp-journals-10088-11218

License: CC BY-NC 4.0

Published Online: 12-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


A young adolescent female presented with swelling over the right jaw for the past 4 months. The biopsy showed a giant cell tumor of the mandible and was planned for excision with free fibular graft placement for coverage but blood investigations showed markedly elevated calcium levels (13.92 mg/dL; normal: 8.6–10.3 mg/dL), and the patient was referred to the Endocrine Surgery Department for further management. High-resolution ultrasonography (HR-USG) of the neck showed a well-defined hypoechoic lesion (9.5 × 8.9 × 28.7 mm) below the right thyroid lobe suggestive of a parathyroid adenoma, which was concordant with a99mTc-Sestamibi (MIBI) scan. The second patient was a young adult female in her early 30s with swelling in the jaw for 3.5 years with a history of fractures following trivial trauma. The patient was evaluated with a biopsy suggestive of a brown tumor. Biochemical investigations showed markedly raised serum calcium levels (13.41 mg/dL). High-resolution ultrasonography demonstrated a left superior parathyroid adenoma with a concordant MIBI scan. Both the patients underwent focused parathyroidectomy and had a considerable reduction in the size of the swelling at the 6-month follow-up. The jaw lesions were determined to be brown tumors of hyperparathyroidism (BTH), which are non-neoplastic, reactive tissue responses associated with primary hyperparathyroidism (PHPT). Distinguishing BTH from other giant cell-containing lesions and malignancies is crucial. It is often misdiagnosed, emphasizing the importance of considering PHPT in patients with unusual bone lesions. While these tumors often regress spontaneously with the correction of hypercalcemia and PHPT, surgical removal may be considered in cases with specific indications such as large tumor size, risk of pathological fractures, compression symptoms, or slow regression. Careful evaluation and diagnosis are essential to avoid unnecessary surgical procedures. These cases highlight the challenging diagnosis of BTH associated with PHPT in patients initially presenting with jaw lesions.

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