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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

Sign of calcification in the left femur.
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fig11: Sign of calcification in the left femur.

Mentions: To assess the parathyroid gland, MRI of neck was advised which revealed small lobulated hyperintense lesion size 13.5 × 12.5 mm at the inferolateral aspect of the right lobe of parathyroid gland (Figure 7). Considering the clinical, radiographic, histopathological, and haematological findings, we arrived to the final diagnosis of brown tumour of maxilla secondary to primary HPT. Surgical treatment of the pathology was planned under general anaesthesia. Three days prior to surgery, to optimize calcium levels, zoledronic acid (bisphosphonate) in 100 mL normal saline was administered intravenously over 15–30 minutes. 3 litres of normal saline was also administered daily to maintain hydration. Along with right inferior lobe parathyroidectomy to control primary HPT, surgical curettage of maxillary lesion was performed with primary closure under one-time general anaesthesia (Figures 8(a) and 8(b)). On histopathological examination, excised gland was suggestive of adenoma and curettage material from right maxilla was consistent with CGCG. No postoperative complications occurred and the lesion healed uneventfully (Figure 9). Oral calcium supplementations in addition to Vitamin D3 were also prescribed for possible postoperative hypocalcaemia. The patient has been followed up from the last 1 year and there has been regression in maxillary swelling. Postoperative radiographs were advised after every 6 months which show signs of calcification and remodelling (Figures 10 and 11).


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)

Sign of calcification in the left femur.
© Copyright Policy
Related In: Results  -  Collection

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

fig11: Sign of calcification in the left femur.
Mentions: To assess the parathyroid gland, MRI of neck was advised which revealed small lobulated hyperintense lesion size 13.5 × 12.5 mm at the inferolateral aspect of the right lobe of parathyroid gland (Figure 7). Considering the clinical, radiographic, histopathological, and haematological findings, we arrived to the final diagnosis of brown tumour of maxilla secondary to primary HPT. Surgical treatment of the pathology was planned under general anaesthesia. Three days prior to surgery, to optimize calcium levels, zoledronic acid (bisphosphonate) in 100 mL normal saline was administered intravenously over 15–30 minutes. 3 litres of normal saline was also administered daily to maintain hydration. Along with right inferior lobe parathyroidectomy to control primary HPT, surgical curettage of maxillary lesion was performed with primary closure under one-time general anaesthesia (Figures 8(a) and 8(b)). On histopathological examination, excised gland was suggestive of adenoma and curettage material from right maxilla was consistent with CGCG. No postoperative complications occurred and the lesion healed uneventfully (Figure 9). Oral calcium supplementations in addition to Vitamin D3 were also prescribed for possible postoperative hypocalcaemia. The patient has been followed up from the last 1 year and there has been regression in maxillary swelling. Postoperative radiographs were advised after every 6 months which show signs of calcification and remodelling (Figures 10 and 11).

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