Brown Tumor of the Palate as First Manifestation of a Primary Hyperparathyroidism

Novac Elena Roxana^1, , Alexandru Florescu² and Dumitru Branisteanu²

¹Emergency Hospital, Moinesti

²St. Spiridon Hospital, Iassy, Romania

Cite this paper

Novac Elena Roxana, Alexandru Florescu and Dumitru Branisteanu. Brown Tumor of the Palate as First Manifestation of a Primary Hyperparathyroidism. American Journal of Medical Case Reports. 2018; 6(12):230-232. doi: 10.12691/AJMCR-6-12-1

Abstract

Brown tumors represent a late-stage bone change caused by primary hyperparathyroidism, presenting in only 2-3 percent of the cases. Therefore as primary manifestations there is even a smaller percent. The common sites of brown tumor are the long bones, ribs, clavicle or pelvic girdle. The solitary palate brown tumor as initial presentation of a primary hyperparathyroidism is rare and often accompanied by tumors of other facial bones. We present the case of a 67 year old woman with initial presentation of a large tumor of the right palate, with no extension to the orbits. The first histological diagnosis was of a giant cell tumor, which delayed the diagnosis of the underlying cause for about 6 months, when the patient’s relatives requested a second opinion on the initial histological findings, the second analysis revealed the same diagnosis but recommended that a primary or secondary hyperparathyroidism should be excluded as the brown tumor is very similar to the one with giant cells. We received the patient at this moment when we immediately diagnosed a primary hyperparathyroidism and sent the patient to surgery. Unfortunately in this case the long progression of high levels of PTH affected a lot the mineral density of the bones and now the patient is highly osteoporotic. The particularity of the case is the location of the brown tumor and the delayed diagnosis of a first primary hyperparathyroidism.

Keywords

brown tumor, giant cell tumor, hyperparathyroidism, osteoporosis

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Wiener Knochengeschwulstregister am Klinischen Institut für Klinische Pathologie, Universität Wien-Differential diagnosis of giant cell tumor of bone, Verh Dtsch Ges Pathol. 1998; 82: 154-9.
[2]	Rossi B1, Ferraresi V, Appetecchia ML, Novello M, Zoccali C..-Giant cell tumor of bone in a patient with diagnosis of primary hyperparathyroidism: a challenge in differential diagnosis with brown tumor. Skeletal Radiol. 2014 May; 43(5): 693-7.
[3]	Jiménez-Montero JG1, Lobo-Hernández E, Picado-Larios A, Molina MA.-Secondary hyperparathyroidism after removal of a parathyroid adenoma. Endocr Pract. 2002 Nov-Dec; 8(6): 429-32.
[4]	Elizabeth A. Mittendorf, MD; Christopher R. McHenry, MD-Persistent Parathyroid Hormone Elevation Following Curative Parathyroidectomy for Primary Hyperparathyroidism, Arch Otolaryngol Head Neck Surg. 2002; 128(3): 275-279.
[5]	Ju Hee Choi,1 Kyoung Jin Kim,1 Ye Jin Lee,1 Sun Hwa Kim, 1 Sin Gon Kim,1 Kwang Yoon Jung,2 Dong Seop Choi, 1 and Nam Hoon Kim-Primary Hyperparathyroidism with Extensive Brown Tumors and Multiple Fractures in a 20-Year-Old Woman, Endocrinol Metab (Seoul). 2015 Dec; 30(4): 614-619.