Maxillary brown tumor as initial presentation of parathyroid adenoma: A case report

Sia, Hon-Ke; Hsieh, Ming‐Chia; Yang, Liheng; Tu, Shih‐Te

doi:10.1016/j.kjms.2012.02.008

Cited by 23 publications

(20 citation statements)

References 19 publications

(25 reference statements)

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“…Metastasis and local recurrence remains the only definitive marker of malignant disease,25 presenting challenges in itself as misnomers may emerge, such as brown tumours. They are rare manifestations of prolonged hyperparathyroidism, accounting for less than 2% of presentations 26. Brown tumours are clinically challenging to diagnose as they often mimic malignancy 27 28.…”

Section: Discussionmentioning

confidence: 99%

Atypical presentation of oncocytic parathyroid adenoma masquerading as metastatic carcinoma

Abdulla

Shamil²,

Wilsher

et al. 2019

BMJ Case Rep

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Parathyroid carcinoma is the rarest endocrine malignancy. Definitive diagnosis is challenging as it is difficult to distinguish malignant from benign disease. A 71-year-old man presented with weight loss and hypercalcaemia. CT scans revealed multiple lung nodules and lytic bone lesions that were consistent with metastatic dissemination. Technetium-99m-sestamibi-single-photon emission computed tomography scan showed an abnormal uptake in the right thyroid lobe. Fine-needle aspiration (FNA) was performed on three occasions. The patient underwent parathyroidectomy with ipsilateral hemithyroidectomy without postoperative complications. Microscopic examination showed a parathyroid neoplasm with fibrosis and intravascular tumour on a background of unremarkable thyroid parenchyma. This resulted in an initial impression of parathyroid carcinoma. Further review by two independent pathologists provided a final diagnosis of oncocytic parathyroid adenoma. This case highlights the subjectivity and interobserver variation with endocrine histological examination. FNA can induce changes that mimic parathyroid carcinoma on histology. An index of suspicion for benign parathyroid adenomas should be maintained.

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Section: Discussionmentioning

confidence: 99%

Atypical presentation of oncocytic parathyroid adenoma masquerading as metastatic carcinoma

Abdulla

Shamil²,

Wilsher

et al. 2019

BMJ Case Rep

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“…The remaining cases are due to hyperplasia of the parathyroid gland, or parathyroid carcinoma in less than 0.5% of cases (5). Most cases of primary hyperparathyroidism are sporadic, but there is a higher incidence in patients with a history of exposure to neck irradiation, and approximately 5% of cases are familial (6).…”

Section: Discussionmentioning

confidence: 99%

“…Long-term increased secretion of PTH enhances bone mobilization through rapid osteoclast turnover and contributes to the formation of brown tumors, also called osteitis fibrosa cystica (a reparative cellular process and not a true neoplasm), which commonly affects the ribs, clavicle, tibia, femur and pelvic girdle (5,9). The term brown tumor is derived from the characteristic appearance of brownish material within the cystic lesion.…”

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confidence: 99%

Regression of orbital brown tumor after surgical removal of parathyroid adenoma

Oliveira

Makimoto

Scalissi

et al. 2015

Arch. Endocrinol. Metab.

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SUMMARYBrown tumors are rare skeletal manifestations that occur in less than 2% of primary hyperparathyroidism (PHPT) cases. Even rarer is the occurrence of brown tumor of the orbit, and few cases have been reported around the world. The rare instance of this benign tumor has prompted us to report the case and treatment of an orbital brown tumor in a patient with PHPT caused by parathyroid adenoma. We present the case of a patient undergoing follow-up at a referral center. The 60-year-old female patient, presented herself with progressive swelling in the nasal region, epistaxis and proptosis, she had noticed seven months prior to our examination. Multiple imaging and laboratory findings revealed parathyroid hormone (PTH)-dependent hypercalcemia (total calcium = 14.3 mg/dL and PTH = 1,573 pg/mL), a nodular lesion in the upper pole of the left thyroid lobe and increased uptake in left upper cervical region. The patient underwent left superior parathyroidectomy in September 2011, which led to the normalization of hypercalcemia and regression of the orbital tumor, as seen on control CT scan. This case highlights the spontaneous regression of the brown tumor after surgical management of the parathyroid adenoma. Arch Endocrinol Metab. 2015;59(5):455-9

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“…Thus, the differential diagnoses involves radiolucent lesions, as ameloblastoma, cystic lesions, and giant cell granuloma; mixed lesions as cementomas, myxoma, and adenomatoid odontogenic tumor; and radiopaque lesions, as fibrous dysplasia. 20 This lesion can be confused with the classical hyperparathyroid brown tumor, which may occur almost anywhere in the human skeleton, 9 although the occurrence in the maxilla [21][22][23] and in the mandible has also been reported. [24][25][26] They are histologically indistinguishable from central giant cell granuloma, a giant cell lesion uniquely seen in the jaws.…”

Section: Discussionmentioning

confidence: 99%

Management of Ossifying Fibroma in a Suspicious Case of Hyperparathyroid–Jaw Tumor Syndrome

Marchiori

Isom

Indresano

2015

Craniomaxillofacial Trauma & Reconstruction

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).Calcium metabolism is primarily regulated by parathyroid hormone (PTH), a polypeptide secreted by the parathyroid glands in response to a decreased serum level of ionized calcium. 1 This peptide prevents hypocalcemia by acting on multiple target organs. It increases bone turnover, releasing calcium into the circulation; increases the tubular resorption of calcium and phosphate excretion in the kidneys; and enhances the activity of renal α-1-hydroxylase, responsible for activating the vitamin D, which induces the calcium uptake in the intestine. 2 Three categories of Hyperparathyroidism (HPT) are recognized. The primary HPT is due to hypersecretion of PTH by one or more parathyroid glands, as a result of benign parathyroid adenoma (85%), primary parathyroid hyperplasia (10-20%) and, more rarely, is attributed to parathyroid carcinoma (1%). 2 The secondary HPT is due mainly to chronic renal insufficiency, and most of the patients develop the disease at the time that hemodialysis starts. 3 In this condition, abnormalities in the renal tubular absorption of phosphate results in reduced phosphate excretion, and renal synthesis of vitamin D is also impaired. The association of hyperphosphatemia and reduced vitamin D levels result in hypocalcemia and, consequently, oversecretion of PTH, resulting in parathyroid hyperplasia. 4 After restoration of renal disease by transplantation, the hyperplastic glands should return to normal functional states. However, in a small percentage of patients it does not occur, resulting in the rarest form of HPT, the tertiary HPT. 3 The primary HPT is usually a sporadic disorder, with a prevalence of 1 to 2% and, in less than 10% of the cases, it is part of hereditary familial syndromes, namely, multiple endocrine neoplasia type 1 (MEN1) and type 2A (MEN2A); HTP-jaw tumor syndrome (HTP-JT); familial hypocalciuric hypercalcemia (FHH); and familial isolated HTP (FIHP). 2,5,6 These hypercalcemic diseases are usually associated with abnormal expression of an oncogene, which can transform a normal cell into a tumor cell, or due to loss of a tumor suppressor gene, also referred to as recessive oncogenes or antioncogenes, that normally inhibit cell proliferation. 7 The aim of this study is to report a clinical case of ossifying fibroma in the mandible associated with HPT-JT syndrome, which was characterized clinically and radiographically, treated with surgical resection as well as mandibular reconstruction in a second surgical intervention, followed by implant placement. Keywords► hyperparathyroidism ► primary ► hypercalcemia AbstractThe purpose of this article is to report a case of ossifying fibroma in the mandible associated with hyperparathyroid-jaw tumor syndrome, in a 46-year-old Caucasian female, surgically resected and reconstructed with iliac crest bone, followed by implant placement. This is a rare syndrome with an autosomal dominant pattern, with the development of primary hyperparathyroidism mainly due to parathyroid adenomas. Fibro-osseous lesions in the jaws can be present and ca...

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Maxillary brown tumor as initial presentation of parathyroid adenoma: A case report

Cited by 23 publications

References 19 publications

Atypical presentation of oncocytic parathyroid adenoma masquerading as metastatic carcinoma

Atypical presentation of oncocytic parathyroid adenoma masquerading as metastatic carcinoma

Regression of orbital brown tumor after surgical removal of parathyroid adenoma

Management of Ossifying Fibroma in a Suspicious Case of Hyperparathyroid–Jaw Tumor Syndrome

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