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Brown tumour of the maxilla and mandible: a rare complication of tertiary hyperparathyroidism

F Selvi*,1, S Cakarer1, R Tanakol2, SD Guler3 and C Keskin1

1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Turkey; 2Department of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Turkey; 3Department of Tumour Pathology and Oncology Cytology, Istanbul University, Turkey


Figure 1
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  		Figure 1 Severe enlargement of the mandible. Note displacement of the teeth in the related area and the tongue being forced to the pharynx, nearly obstructing the airway. Minor ulceration visible on the dorsum of the lesion

 

Figure 2
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  		Figure 2 Maxillary enlargement. Expansive mass at the level of the apices of the right maxillary molar teeth

 

Figure 3
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  		Figure 3 Panoramic radiograph of the maxillary and mandibular lesions. A well-demarcated radiolucent area, starting at the left mandibular canine tooth and extending to the right second molar tooth is shown. Another osteolytic area is visible at the apex of the left mandibular molar teeth. The maxillary lesion is not clearly distinguishable on this panaromic radiograph

 

Figure 4
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  		Figure 4 CT scans of the related areas confirmed the presence of intraosseous radiolucent lesions. The brown tumours on both sides of the mandible are clearly visible

 

Figure 5
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  		Figure 5 CT scans of the maxillary lesion reveal the lesion to be penetrating the right maxillary sinus

 

Figure 6
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  		Figure 6 Ultrasonography of the parathyroid glands revealed solid hypoechogenic parathyroid lesions on both sides of the lower poles of the thyroid lobes. Arrow indicates the hypoechogenic solid parathyroid lesion at the lower pole of the right thyroid lobe.

 

Figure 7
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  		Figure 7 Parathyroid technetium scintiscan showing abnormally high uptake in both sides of the mandible and shoulders as well as on the sternum and right anterior part of the ribs. Abnormally high uptake is also observed at the lower pole of the right and left thyroid lobes

 

Figure 8
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  		Figure 8 Giemsa stain. Histopathological examination showing a multinucleated giant cell arranged within erythrocytes and some connective tissue elements (magnification x 200)

 




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