Mandibular Brown Tumor as a Result of Secondary Hyperparathyroidism—Radiological and Clinical Pitfalls and Dilemmas

TL;DR

This paper presents a case of a rare jaw tumor caused by secondary hyperparathyroidism, highlighting diagnostic challenges and the need for surgery in some cases.

Contribution

The paper emphasizes the diagnostic difficulties of mandibular brown tumors and the potential need for surgical intervention despite systemic treatment.

Findings

Brown tumors in the mandible can mimic aggressive jaw lesions, leading to diagnostic challenges.

Systemic endocrine therapy may not halt lesion progression in some patients, requiring surgical excision.

Comprehensive evaluation combining clinical, radiological, and histopathological data is crucial for accurate diagnosis.

Abstract

Brown tumors (BTs) are rare osteolytic lesions that typically occur in association with primary or secondary hyperparathyroidism (PHP and SHP). Excessive secretion of parathyroid hormone induces increased bone resorption, resulting in lesions characterized by fibrosis, vascularization, and hemosiderin deposition. The most common sites include the jaws, ribs, pelvis, and long bones. Clinical manifestations may involve pain, swelling, or pathological fractures. We present the case of a mandibular BT in a 48-year-old female with chronic renal failure and secondary hyperparathyroidism. The patient exhibited progressive mandibular swelling with radiological features resembling an aggressive odontogenic or malignant lesion. Laboratory analysis confirmed markedly elevated parathyroid hormone levels, while scintigraphy demonstrated increased focal uptake in the mandible and ribs. Histopathological evaluation revealed multinucleated giant cells within a fibrous stroma, consistent with BT. Despite initiation of systemic endocrine therapy, the lesion continued to enlarge, necessitating complete surgical excision of the mandibular mass. This case underscores the diagnostic dilemmas of mandibular BT, which may closely mimic aggressive jaw pathologies. Importantly, while many BTs regress after systemic management of hyperparathyroidism, this case illustrates that surgical excision may be unavoidable in patients with unstable systemic status or progressive local disease. Comprehensive clinical, radiological, laboratory, and histopathological evaluation remains essential to ensure timely diagnosis and appropriate treatment.

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