A Giant-Cell Lesion with Cellular Cannibalism in the Mandible: Case Report and Review of Brown Tumors in Hyperparathyroidism

Abstract

A small radiolucent area in the mandible was discovered in a 58-year-old woman with no oral complaints. The patient's history included only hypertension. The lesion was considered as an inflammatory cyst and was enucleated. Three months later, a CT revealed the presence of a cyst-like lesion in the mandible with thin expanded buccal cortical plate, localized erosion, and a polylobate appearance on the lingual aspect of the cortical plate. The histological diagnosis of the lesion was central giant-cell granuloma (CGCG). The lesion was thoroughly enucleated. Nevertheless, another X-ray carried out six months later revealed multiple bilateral osteolytic areas throughout the jaw. In addition, widespread cortical plate erosion was observed, as well as signs of root resorption and periodontal enlargement. There was no sign of neurological involvement, although the nerves appeared to be dislocated. After full blood chemistry analysis and detailed collection of radiographs, the final diagnosis was brown tumors in primary hyperparathyroidism. This case report demonstrates how dental clinicians may be the first-line specialists who identify a complex systemic disease before other clinicians. Finally, it highlights the role of cellular cannibalism in predicting the clinical aggressiveness of brown tumors as well as in other giant-cell lesions.

Giant Cells Lesions of Oral and Maxillofacial Region – A Proposed Diagnostic Algorithm

“…Additionally, the latter shows multifocal lesions, increased parathormone, hypercalcemia, and hypophosphataemia. [9] Ultrasound, CT scan, or technetium scan techniques can also be used to detect the diseased parathyroid gland. [9,10] Case 3 in the present study shows multiple osteolytic lesions in the mandible and clivus with histopathology of giant cell granuloma and prominent areas of hemorrhage.…”

“…[9] Ultrasound, CT scan, or technetium scan techniques can also be used to detect the diseased parathyroid gland. [9,10] Case 3 in the present study shows multiple osteolytic lesions in the mandible and clivus with histopathology of giant cell granuloma and prominent areas of hemorrhage. An increase in serum PTH levels favored the diagnosis of Brown tumor of HPT.…”

“…[6] Hybrid lesions of giant cell lesions have been reported in association with fibro-osseous lesions, Noonan syndrome, neurofibromatosis1, odontogenic keratocyst, and central odontogenic fibroma, etc. [7][8][9][10][11][12][13] Our case presented as a rarity of hybrid lesion of odontogenic keratocyst with giant cell granuloma (Case 6 (Figure 4)). This may represent a collision tumor or reactive formation of giant cells in OKC or the possibility of a rare variant.…”

“…[5,6] However, in some lesions they present a diagnostic dilemma because of uncharacteristic histopathological appearance, thus emphasizing a need for exploring clinical, radiological, and other details to arrive at a final diagnosis. [7][8][9][10][11][12][13] Perplexingly, sometimes, the presence of giant cells can just be an additional non-diagnostic finding. [14,15] This study aimed to study the prevalence of GCL pertaining to the oral and maxillofacial regions in our department and dissertate GCLs along with the differential diagnosis, special stains, and other investigations, necessary for their characterization and propose a tentative diagnostic scheme for GCLs.…”

Computed Tomography Three-Dimensional Reconstruction Algorithm in the Diagnosis of Periodontitis and Its Correlation with Hypertension

“…Under such a limited angle, there will be serious artifacts in reconstructed image. On the basis of the original equipment that does not affect the normal diagnosis, how to efficiently reduce the royal radiation dose to help the doctor in imaging has become a major issue in imaging [9]. Iterative reconstruction (IR) algorithm is a new infrared ray technology that can get the images conforming to the diagnostic requirements under lower scanning conditions.…”