Highly Aggressive Brown Tumor in the Jaw Associated with Tertiary Hyperparathyroidism

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 7/24/2009
Article title: Highly Aggressive Brown Tumor in the Jaw Associated with Tertiary Hyperparathyroidism
Author(s): Pinto LP, Cherbinim K, Salum FG, et al.
Journal: Pediatric Dentistry
Volume (number): 28(6)
Date: 2006
Major topic: Brown Cell tumor diagnosis and management
Type of Article: Case Report
Main Purpose: This case report describes a 12 year old female with an aggressive brown tumor associated with tertiary hyperparathyroidism and treated medically with calcitonin and corticosteroids.
Review of Case: Brown tumors are central giant cell granulomas which develop as a result of untreated hyperparathyroidism. The tumor affects mainly children and young adults with a female predilection. It represents less than 7% of all benign jaw lesions. The primary form of hyperparathyroidism relates of a hyperplastic or neoplastic parathyroid gland. Secondary occurs due to chronic renal insufficiency and tertiary is secondary with spread of parathyroid glands to other sites. Brown tumors occur in 1.5-1.7% of patients with chronic renal insufficiency. Treatment is focused around solving the underlying endocrine abnormatlity. The brown color is derived from hemorrhay and hemosiderin infiltration of the lesion.
The 12 yewar old female presented with right buccal lesion noted 3 months ago, and had a firm consistency. The panorex revealed a large osteolytic lesion. Blood tests revealed elevated blood creatinine levels, parathyroidhormone and alkaline phosphatase. Histology confirmed the diagnosis. Other radiographs showed lesions on the left humerus, pelvis, and right femur. Dialysis controlled the creatinine levels and a parathyroidectomy of the upper left gland reduced the PTH levels. Due to the extension of the lesions, treatment with inhaled salmon calcitonin, and intralesional triancinolone once per week was undertaken. After 12 weeks, the lesion became calcified. A renal transplant was performed and the patient is free of clinical and radiographic signs of relapse.
Discussion: In patients with renal insufficiency, PTH contrations become elevated in response to hypocalcemia, hyperphosphatemia, and vitamin D defiency. Parathyroid gland increases in size and may enlarge or develp neoplasia. In some cases partial to complete parathyroidectomy is effective in reducing PTH concenctration and treating the lesion. This study illustrates the first casein which both calcitonin and intralesional corticosteroid injections. The calcitonin blocks the effects of PTH and the corticosteroids prevent osteoclastic giant cell activity.
Key points/Summary : Brown tumors are central giant cell granulomas with an underlying parathyroid disorder. Non-surgical intervention using a combination of inhaled calcitonin and intra-lesional injections successfully treated this case
Assessment of article: Good article.