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Central giant cell granuloma of posterior maxilla: first expression of primary hyperparathyroidism.

Gulati D, Bansal V, Dubey P, Pandey S, Agrawal A - Case Rep Endocrinol (2015)

Bottom Line: Immunoassay of parathyroid hormone (PTH) level was found to be highly elevated.Surgical removal of the bony lesion was done by curettage.The patient has been followed up for 1 year with no postoperative complications and the lesion healed uneventfully.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut 250005, India.

ABSTRACT
A case of 19-year-old male patient reported with the chief complaint of slowly growing diffuse painless swelling over the right part of the face from last 6 months. Intraoral examination revealed a swelling on right side of palate in relation to molar region with buccal cortical plate expansion. Radiographic examination (orthopantograph and 3DCT) showed large multilocular radiolucency in right maxilla with generalized loss of lamina dura. Incisional biopsy was done and specimen was sent for histopathological examination which showed multinucleated giant cells containing 15-30 nuclei. Based on clinical, radiological, and histopathological findings provisional diagnosis of central giant cell granuloma was made. Blood tests after histopathology demonstrated elevated serum calcium level and alkaline phosphatase level. Immunoassay of parathyroid hormone (PTH) level was found to be highly elevated. Radiographic examination of long bones like humerus and femur, mandible, and skull was also done which showed osteoclastic lesions. Considering the clinical, radiographic, histopathological, and blood investigation findings, final diagnosis of brown tumour of maxilla was made. The patient underwent partial parathyroidectomy under general anaesthesia to control primary hyperparathyroidism. Surgical removal of the bony lesion was done by curettage. The patient has been followed up for 1 year with no postoperative complications and the lesion healed uneventfully.

No MeSH data available.


Related in: MedlinePlus

Swelling over the right cheek region.
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fig1: Swelling over the right cheek region.

Mentions: A 19-year-old young adult visited the outpatient clinic of the Department of Oral Surgery at Subharti Dental College with swelling over the right part of face from the last 6 months (Figure 1). The patient had undergone tooth extraction 6 months back. After 3-4 days, there was presence of swelling. Initially swelling was small in size, approximately 1 cm in diameter. There was no tenderness. Then there was gradual increase in size of swelling. The patient went to a nearby doctor where medications were prescribed. But there was no relief. Extraoral examination revealed facial asymmetry due to diffuse asymptomatic swelling starting from the lateral corner of the mouth and extending up to angle region of the same side. There was no change in colour of skin with any increase in temperature of overlying skin. On palpation, lymph nodes were not palpable. Intraorally, inflamed lesion with distinct border presented distal to the second premolar extending up to maxillary tuberosity region, approximately 2 cm in size. There was expansion of buccal cortical plate with expansion of palatal bone (Figure 2). The adjacent mucosa was normal in colour. All teeth were vital and the nerve sensibility was not disturbed. Panoramic radiography showed a multilocular radiolucent lesion suggestive of osteolysis in the right maxilla region. The lesion was extended from the root of the right upper canine to the maxillary tuberosity region and caused resorption of the first maxillary molar root. Unilocular radiolucency was also observed below the condylar process and frontal bone. Another prominent feature which was observed was generalised loss of lamina dura (Figure 3). Based on clinical and radiographic findings, differential diagnosis of CGCG, ameloblastoma, and odontogenic myxoma was made. Later a computed tomography was advised which showed a large expansible lesion in right maxillary sinus causing erosion of its walls causing destruction of alveolar process of upper maxilla compressing and bulging into the right nasal cavity (Figure 4). To further confirm the diagnosis, long bone radiographs were advised which showed osteoporotic lesion in right humerus and left femur bone (Figure 5). Generalized loss of lamina dura, maxillary alveolar bone demineralization, and multiple osteoporotic lesions in long bone are highly suggestive of brown tumour. Ideally parathyroid assay needs to be assessed before biopsy. But, due to financial constraint and availability of limited resources in our centre, biochemical investigations like PTH levels were not able to be performed before the biopsy.


Central giant cell granuloma of posterior maxilla: first expression of primary hyperparathyroidism.

Gulati D, Bansal V, Dubey P, Pandey S, Agrawal A - Case Rep Endocrinol (2015)

Swelling over the right cheek region.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4321084&req=5

fig1: Swelling over the right cheek region.
Mentions: A 19-year-old young adult visited the outpatient clinic of the Department of Oral Surgery at Subharti Dental College with swelling over the right part of face from the last 6 months (Figure 1). The patient had undergone tooth extraction 6 months back. After 3-4 days, there was presence of swelling. Initially swelling was small in size, approximately 1 cm in diameter. There was no tenderness. Then there was gradual increase in size of swelling. The patient went to a nearby doctor where medications were prescribed. But there was no relief. Extraoral examination revealed facial asymmetry due to diffuse asymptomatic swelling starting from the lateral corner of the mouth and extending up to angle region of the same side. There was no change in colour of skin with any increase in temperature of overlying skin. On palpation, lymph nodes were not palpable. Intraorally, inflamed lesion with distinct border presented distal to the second premolar extending up to maxillary tuberosity region, approximately 2 cm in size. There was expansion of buccal cortical plate with expansion of palatal bone (Figure 2). The adjacent mucosa was normal in colour. All teeth were vital and the nerve sensibility was not disturbed. Panoramic radiography showed a multilocular radiolucent lesion suggestive of osteolysis in the right maxilla region. The lesion was extended from the root of the right upper canine to the maxillary tuberosity region and caused resorption of the first maxillary molar root. Unilocular radiolucency was also observed below the condylar process and frontal bone. Another prominent feature which was observed was generalised loss of lamina dura (Figure 3). Based on clinical and radiographic findings, differential diagnosis of CGCG, ameloblastoma, and odontogenic myxoma was made. Later a computed tomography was advised which showed a large expansible lesion in right maxillary sinus causing erosion of its walls causing destruction of alveolar process of upper maxilla compressing and bulging into the right nasal cavity (Figure 4). To further confirm the diagnosis, long bone radiographs were advised which showed osteoporotic lesion in right humerus and left femur bone (Figure 5). Generalized loss of lamina dura, maxillary alveolar bone demineralization, and multiple osteoporotic lesions in long bone are highly suggestive of brown tumour. Ideally parathyroid assay needs to be assessed before biopsy. But, due to financial constraint and availability of limited resources in our centre, biochemical investigations like PTH levels were not able to be performed before the biopsy.

Bottom Line: Immunoassay of parathyroid hormone (PTH) level was found to be highly elevated.Surgical removal of the bony lesion was done by curettage.The patient has been followed up for 1 year with no postoperative complications and the lesion healed uneventfully.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut 250005, India.

ABSTRACT
A case of 19-year-old male patient reported with the chief complaint of slowly growing diffuse painless swelling over the right part of the face from last 6 months. Intraoral examination revealed a swelling on right side of palate in relation to molar region with buccal cortical plate expansion. Radiographic examination (orthopantograph and 3DCT) showed large multilocular radiolucency in right maxilla with generalized loss of lamina dura. Incisional biopsy was done and specimen was sent for histopathological examination which showed multinucleated giant cells containing 15-30 nuclei. Based on clinical, radiological, and histopathological findings provisional diagnosis of central giant cell granuloma was made. Blood tests after histopathology demonstrated elevated serum calcium level and alkaline phosphatase level. Immunoassay of parathyroid hormone (PTH) level was found to be highly elevated. Radiographic examination of long bones like humerus and femur, mandible, and skull was also done which showed osteoclastic lesions. Considering the clinical, radiographic, histopathological, and blood investigation findings, final diagnosis of brown tumour of maxilla was made. The patient underwent partial parathyroidectomy under general anaesthesia to control primary hyperparathyroidism. Surgical removal of the bony lesion was done by curettage. The patient has been followed up for 1 year with no postoperative complications and the lesion healed uneventfully.

No MeSH data available.


Related in: MedlinePlus