Brown tumors in dialyzed patients with secondary hyperparathyroidism: Report of 16 cases

Abstract

Brown tumors (BTs) are relatively uncommon but they are serious complications of renal osteodystrophy. The objective of this study was to analyze the clinical, biological, and radiological characteristics of 16 patients with BTs provoked by secondary hyperparathyroidism (sHPT) and its response to the decrease in parathyroid hormone levels after parathyroidectomy (PTX). The management of that uncommon condition was also reviewed. We conducted a retrospective study including 16 end-stage renal disease patients who underwent subtotal PTX between 1997 and 2007 for severe sHPT with BTs. Our study included 10 men and 6 women, whose average age was 34 years. All patients were on dialysis. Ten of them were on dialysis for more than 5 years. The median duration on dialysis was 84 months. Patients included suffered from swellings associated with functional limitations. BTs had multiple locations in 7 patients. Jaw was the most frequent location (62%). Radiography and tomodensitometry demonstrated a mixed radio lucent and radio-opaque lesions with an expansion of the cortical bone. Bone scan demonstrated an increased uptake of lesions. Chirurgical treatment was indicated in all cases because of severe refractory sHPT with functional limitations and/or disfiguring deformities. In all cases, BTs stopped its progression and even decreased in size. However, it was insufficient in four cases, which required a surgical resection. PTX remains an efficacious approach in resistant cases of sHPT with persistent BTs.

The osseous and dental changes of patients with chronic renal failure by CBCT

“…29 Secondary hyperparathyroidism is a frequent complication of CRF, and brown tumours are seen in 1.50-1.75% of patients with secondary hyperparathyroidism. 30 These tumours are also associated with CRF and are being reported with increasing frequency. 25,30,31 Brown tumours result from the destruction of local bone occurring especially in regions where bone resorption is particularly rapid with haemorrhage and reparative granulation tissue containing giant multinucleated cells replace the normal marrow content.…”

“…30 These tumours are also associated with CRF and are being reported with increasing frequency. 25,30,31 Brown tumours result from the destruction of local bone occurring especially in regions where bone resorption is particularly rapid with haemorrhage and reparative granulation tissue containing giant multinucleated cells replace the normal marrow content. 30 The majority of brown tumour cases reported the jaws as the main sites of occurrence.…”

“…25,30,31 Brown tumours result from the destruction of local bone occurring especially in regions where bone resorption is particularly rapid with haemorrhage and reparative granulation tissue containing giant multinucleated cells replace the normal marrow content. 30 The majority of brown tumour cases reported the jaws as the main sites of occurrence. 32 In tomography scans, brown tumour shows an osseous mass, with no cortical disruption, no periosteal reaction, a heterogeneous centre and areas that suggest cysts.…”

Facial disfigurement due to osteitis fibrosa cystica or brown tumor from secondary hyperparathyroidism in patients on dialysis: A systematic review and an illustrative case report

“…Thirty-six cases from three articles were excluded from the analysis as they did not have information on the variables we sought to collect as they only provided group patient data and not individual patient data. 14,27,28 Our total sample consisted of 99 articles (see supplementary material). These articles resulted in 127 cases that were included in the analysis (including our case, see supplementary material).…”

“…28 The reasons for increased life expectancy included increased attention to dose of dialysis delivered, changes in dialysis equipment, including a shift from cellulosic to synthetic HD membranes, improved connection devices for PD, and better management of anemia through the wide use of rhEPO and parenteral iron. The young African-American woman had developed ESRD from focal segmental glomerulosclerosis (FSGS) and had HD for 5 years.…”