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Mandibular Brown Tumor of Secondary Hyperparathyroidism Requiring Extensive Resection: A Forgotten Entity in the Developed World?

Qaisi M, Loeb M, Montague L, Caloss R - Case Rep Med (2015)

Bottom Line: This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT.It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT.Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.

View Article: PubMed Central - PubMed

Affiliation: Oral-Head & Neck Oncology/Microvascular Surgery, Department of Oral-Maxillofacial Surgery & Pathology and Department of Otolaryngology, Cancer Institute, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.

ABSTRACT
Brown tumor of hyperparathyroidism (BTHPT) is rare in the United States and not frequently seen in clinical practice. This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT. Conversely, BTHPT is more common in underdeveloped countries where fewer patients have access to health care and hyperparathyroidism (HPT) goes untreated. It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT. We present a case report of a patient in the United States with a large mandibular BTHPT requiring an extensive resection in the setting of secondary HPT. Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.

No MeSH data available.


Related in: MedlinePlus

Photomicrograph of the mandibular brown tumor showing numerous multinucleated giant cells dispersed in a highly cellular stroma (H&E, magnification ×200).
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fig3: Photomicrograph of the mandibular brown tumor showing numerous multinucleated giant cells dispersed in a highly cellular stroma (H&E, magnification ×200).

Mentions: Microscopically, the lesion was composed of a highly cellular proliferation of bland spindle-shaped fibroblastic cells with numerous multinucleated giant cells (Figure 3) and spicules of woven bone. The osteoclastic giant cells were scattered throughout the cellular stroma and surrounded small spicules of bone (Figure 4). Small blood vessels, extravasated red blood cells, and focal deposits of hemosiderin were seen throughout the lesion, especially toward the periphery. The native bone showed evidence of intense bone resorption secondary to osteoclast hyperactivity and marrow fibrosis, consistent with secondary hyperparathyroidism (Figure 5). The histologic appearance of the lesion was akin to central giant cell reparative granuloma.


Mandibular Brown Tumor of Secondary Hyperparathyroidism Requiring Extensive Resection: A Forgotten Entity in the Developed World?

Qaisi M, Loeb M, Montague L, Caloss R - Case Rep Med (2015)

Photomicrograph of the mandibular brown tumor showing numerous multinucleated giant cells dispersed in a highly cellular stroma (H&E, magnification ×200).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556817&req=5

fig3: Photomicrograph of the mandibular brown tumor showing numerous multinucleated giant cells dispersed in a highly cellular stroma (H&E, magnification ×200).
Mentions: Microscopically, the lesion was composed of a highly cellular proliferation of bland spindle-shaped fibroblastic cells with numerous multinucleated giant cells (Figure 3) and spicules of woven bone. The osteoclastic giant cells were scattered throughout the cellular stroma and surrounded small spicules of bone (Figure 4). Small blood vessels, extravasated red blood cells, and focal deposits of hemosiderin were seen throughout the lesion, especially toward the periphery. The native bone showed evidence of intense bone resorption secondary to osteoclast hyperactivity and marrow fibrosis, consistent with secondary hyperparathyroidism (Figure 5). The histologic appearance of the lesion was akin to central giant cell reparative granuloma.

Bottom Line: This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT.It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT.Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.

View Article: PubMed Central - PubMed

Affiliation: Oral-Head & Neck Oncology/Microvascular Surgery, Department of Oral-Maxillofacial Surgery & Pathology and Department of Otolaryngology, Cancer Institute, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.

ABSTRACT
Brown tumor of hyperparathyroidism (BTHPT) is rare in the United States and not frequently seen in clinical practice. This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT. Conversely, BTHPT is more common in underdeveloped countries where fewer patients have access to health care and hyperparathyroidism (HPT) goes untreated. It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT. We present a case report of a patient in the United States with a large mandibular BTHPT requiring an extensive resection in the setting of secondary HPT. Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.

No MeSH data available.


Related in: MedlinePlus