Perawatan Brown Tumor pada Mandibula Pasien dengan Hiperparatiroid (HPT) Tersier

Hiperparatiroidisme (HPT) merupakan kondisi yang disebabkan oleh meningkatnya produksi dan sekresi hormon paratiroid (PTH). Tipe HPT diklasifikasikan menjadi tiga dan HPT tersier merupakan yang paling jarang terjadi. Kerusakan tulang merupakan komplikasi yang paling sering terjadi pada HPT tersier yaitu sebesar 25% dari total pasien HPT dan brown tumor merupakan salah satu bagian dari komplikasi tersebut. Lesi ini sering terjadi pada tulang kortikal, termasuk mandibula. Pemeriksaan klinis, radiografis, histopatologi, dan biokimia serum dilakukan dalam upaya diagnosis brown tumor. Perawatan brown tumor dilakukan melalui dua pendekatan yaitu bedah dan non-bedah. Tujuan dari penulisan telaah pustaka ini adalah menjelaskan pentingnya diagnosis dan perawatan yang tepat pada kondisi brown tumor pada mandibula oleh dokter gigi sehingga kerusakan yang lebih parah dapat dicegah. Pemilihan jenis perawatan lesi brown tumor yang tepat didapatkan melalui pemeriksaan yang komprehensif sehingga didapatkan hasil perawatan yang memuaskan. Telaah pustaka ini berjenis telaah pustaka naratif. Pencarian pustaka dilakukan melalui sumber elektronik seperti PubMed, Google Scholar, dan Clinical Key dengan kriteria inklusi dan eksklusi tertentu. Kesimpulan dari telaah pustaka ini adalah pemeriksaan klinis, laboratoris, histologis, serta radiografis yang baik menghasilkan diagnosis yang tepat sehingga dapat mencegah keparahan dan mengurangi kerusakan akibat lesi tersebut

Imaging technologies in the differential diagnosis and follow-up of brown tumor in primary hyperparathyroidism: case report and review of the literature

Brown tumors are osteolytic lesions associated with hyperparathyroidism (HPT). They may involve various skeletal segments, but rarely the cranio-facial bones. We report a case of a young boy with a swelling of the jaw secondary to a brown tumor presenting as the first manifestation of primary HPT (PHPT). He was found to have brown tumor located in the skull, as well. Different imaging technologies were employed for the diagnosis and follow-up after parathyroidectomy. We enclose a review of the literature on the employment of such imaging technologies in the differential diagnosis of osteolytic lesions. A multidisciplinary approach comprising clinical, laboratory and imaging findings is essential for the differential diagnosis of brown tumor in PHPT

Tumor pardo en la sínfisis mandibular como primera manifestación clínica de hiperparatiroidismo: diagnóstico y tratamiento

El tumor pardo es una de las lesiones óseas que pueden encontrarse en pacientes con hiperparatiroidismo. Pueden localizarse en cualquier hueso, afectando ocasionalmente al territorio craneo- maxilofacial. Si bien en la mayoría de los casos el diagnóstico de tumor pardo se realiza en pacientes en los que se ha diagnosticado previamente el hiperparatiroidismo, en ocasiones éste puede ser el primer signo de la enfermedad. Presentamos un caso de tumor pardo localizado en la sínfisis mandibular que fue el primer signo clínico de hiperaparatiroidismo secundario a un adenoma paratiroideo hiperfuncionante. Se revisan el diagnóstico diferencial de este tipo de lesiones y sus posibles tratamientos.Brown tumor is one of the lesions that develop in patients with hyperparathyroidism. Any of the squeletal bones can be affected including the cranio-maxillofacial ones. Most of the times the brown tumor appears after a final diagnosis of hyperparathyroidism is made. However brown tumor can be the first clinical sign of the disease. A clinical case in which a brown tumor located in the anterior part of the mandible appears as the first sign of primary hyperparathyroidism is presented. The possible differential clinical diagnosis and the recommended treatments are revised

Parathyroid adenoma in a young female presenting with craniofacial brown tumor and acute pancreatitis – A case report

Solitary Parathyroid adenomas have a diverse clinical presentation. They may be asymptomatic or may sometimes lead to extensive bony resorption and replacement of bone by fibrous tissue, also known as a brown tumor. Brown tumor is a relatively rare presentation of primary hyperparathyroidism and is even rarer in a younger age group. Here, we report the case of a 20-year-old female presenting with craniofacial brown tumor and during the course of hospital stay; she also developed an attack of acute pancreatitis due to hyperparathyroidism. This case report emphasizes the importance of a complete investigative work up in patients presenting with maxillofacial bony lesions for early diagnosis and planning of definitive management

Brown Tumour in a Patient with Secondary Hyperparathyroidism Resistant to Medical Therapy: Case Report on Successful Treatment after Subtotal Parathyroidectomy

Brown tumour represents a serious complication of hyperparathyroidism. Differential diagnosis, based on histological examination, is only presumptive and clinical, radiological and laboratory data are necessary for definitive diagnosis. Here we describe a case of a brown tumour localised in the maxilla due to secondary hyperparathyroidism in a young women with chronic renal failure. Hemodialysis and pharmacological treatment were unsuccessful in controlling secondary hyperparathyroidism making it necessary to proceed with a subtotal parathyroidectomy. The proper timing of the parathyroidectomy and its favourable effect on regression of the brown tumor made it possible to avoid a potentially disfiguring surgical removal of the brown tumor

Brown Tumor of the Cervical Spines: A Case Report with Literature Review

To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion

Large tumor of iliac bone in a young woman imitating malignant disease as a sign of primary hyperparathyroidism

Detection of a bone tumor in a young adult draws suspicion of neoplastic disease. A 22-year-old female was admitted for a bone tumor biopsy. MRI of the pelvis showed an osteolytic lesion at the level of the left sacroiliac joint. Radiologist suggested differential diagnosis between aneurysmal bone cyst and giant cell tumor of bone. Considering the high serum calcium and numerous foci of increased accumulation of the radioisotope on the bone scan, serum iPTH level was evaluated. The diagnosis of hyperparathyroidism was established. Neck ultra­sound revealed focal lesion corresponding to an enlarged parathyroid gland. Parathyroidectomy was performed. The iliac bone tumor showed to be a brown tumor of primary hyperparathyroidism, detected only rarely in adolescents. Non-specific symptoms and lack of routine control of serum calcium in youths make an early diagnosis difficult; moreover, pathological features of brown tumor and giant cell tumor of bone are very similar

A 60-year-old man with chronic renal failure and a costal mass: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Brown tumors are a rare focal manifestation of osteitis fibrosa cystica, which results from hyperparathyroidism. Chronic kidney failure may lead to secondary or tertiary hyperparathyroidism and thus to osteitis fibrosa cystica and brown tumors.</p> <p>Case presentation</p> <p>A 60-year-old man with a history of diabetes mellitus and chronic kidney failure presented with a 15-day history of dyspnea, cough, malaise and fever. Initially, there was little correlation between his history and his physical examination. Various pulmonary, cardiac and infectious etiologies were ruled out. A chest X-ray showed a costal mass that was further verified by tomography and gammagraphy. The mass was suspected of being neoplastic. After a failed biopsy, the mass was removed surgically and on histopathology was compatible with a giant-cell tumor versus a brown tumor caused by hyperparathyroidism. Laboratory tests showed elevated calcium, phosphate and parathyroid hormone concentrations. The patient was diagnosed with a brown tumor secondary to refractory hyperparathyroidism.</p> <p>Conclusion</p> <p>Tending towards a diagnosis because it is more frequent or it implies more risk for the patient may delay the consideration of other diagnostic options that, although rare, fit well into the clinical context. The patient presented here was suspected to have an osseous neoplasia that would have had major implications for the patient. However, reassessment of the case led to the diagnosis of a brown tumor. Brown tumors should be an important diagnostic consideration in patients with chronic kidney failure who have secondary or tertiary hyperparathyroidism and an osseous mass.</p

Brown tumor mimicking metastases-the late manifestation of hyperparathyroidism

Brown tumors are uncommon manifestations of hyperparathyroidism (HPT) that without awareness are easily misdiagnosed as metastases. This short report highlights the importance of clinical context and clear communication between medical specialties when interpreting complex radiologic findings