Craniofacial Brown Tumor in Patients with Secondary Hyperparathyroidism to Chronic Renal Failure: Report of Two Cases in Cipto Mangunkusumo Hospital

Abstract

Brown tumor is a bone lesion that arises in the setting of excess osteoclast activity in hyperparathyroidism. It consists of fibrous tissue, woven bone, and supporting vasculature, while contains no matrix. The characteristic of brown-colored lesion is a result of hemosiderin deposition into the osteolytic cysts. Two cases of young women aged 26 and 29 years old, respectively, are known with a history of end-stage renal disease (ESRD). Dialysis is performed two times/week over the last 7 years. Our patients presented with an intraoral mass of the hard palate since 12 months ago and decreased body height of 10 cm. The lesion causes difficulties in swallowing and talking. Laboratory workup showed elevated parathormone or PTH (3.391 pg/mL and >5.000 pg/mL). Neck ultrasound showed enlargement of the parathyroid glands. Supporting examination to diagnose brown tumor are neck ultrasound, CT of the neck, and parathyroid sestamibi scan. We performed parathyroidectomy. Pathology revealed hyperplasia of the parathyroid. The tumor regressed significantly within 2 weeks following the surgery, and we still observe tumor regression as well as reduction in PTH level. As clinicians, we should be alert to other possible causes of bony lesions. Clinical examination, laboratory finding, and imaging present important information to diagnose brown tumor.

Three Rare Concurrent Complications of Tertiary Hyperparathyroidism: Maxillary Brown Tumor, Uremic Leontiasis Ossea, and Hungry Bone Syndrome

“…However, in some instances, the bone brown tumors can continue to grow after 2 years despite parathyroidectomy [ 31 ]. Thus, surgical excision of the brown tumor itself may be considered, especially if there are anatomic complications such as facial pain or compromised vision, hearing, chewing, speaking, and breathing [ 76 , 79 ]. In this patient, her maxillary brown tumor significantly increased in size (doubling over 1 month), causing impaired oral intake and facial pain.…”

“…https://doi.org/10.11005/jbm.2020.27.3.217 mised vision, hearing, chewing, speaking, and breathing. [76,79] In this patient, her maxillary brown tumor significantly increased in size (doubling over 1 month), causing impaired oral intake and facial pain. Thus, surgical curettage of the maxillary bone lesion and parathyroidectomy were performed to palliate her pain and allow early-resumption of oral diet as her calcium homeostasis stabilized.…”

Association between Attitudes to Self Management on Adherence in Restriction Fluid and Dietary among Patient Hemodialysis Related to Hypervolemia

“…Furthermore, there is a relationship between family support and knowledge level. Patients with chronic kidney disease who do have strong family support will be more cooperative and also nurses should educate patients about the importance of restricting fluid intake and encourage them to involve their families in the program (Kartini et al, 2018) . Opiyo et al, (2019) stated in their study that diet prescriptions including adherence patients in fluid restrictions are more inclined to keep to their eating plans.…”

Epistaxis as an initial symptom of brown tumor in hard palate: a rare case report and review

“…ever, this is not absolute even in cases where the parathyroid hormone is significantly reduced, and tumor relapse may easily occur due to inadequate resection or persistent etiology [31,37]. Persistent or large destructive tumors need to be treated with resection or curettage [38,39].…”