Majic Tengg A, Cigrovski Berkovic M, Zajc I, Salaric I, Müller D, Markota I. Expect the unexpected: Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism. World J Clin Cases 2024; 12(7): 1200-1204 [PMID: 38524508 DOI: 10.12998/wjcc.v12.i7.1200]
Corresponding Author of This Article
Maja Cigrovski Berkovic, MD, Adjunct Associate Professor, Department for Sport and Exercise Medicine, Faculty of Kinesiology University of Zagreb, Horvacanski zavoj 15, Zagreb 10000, Croatia. maja.cigrovskiberkovic@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 6, 2024; 12(7): 1200-1204 Published online Mar 6, 2024. doi: 10.12998/wjcc.v12.i7.1200
Expect the unexpected: Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism
Ana Majic Tengg, Maja Cigrovski Berkovic, Ivan Zajc, Ivan Salaric, Danko Müller, Iva Markota
Ana Majic Tengg, Department of Endocrinology, Diabetes, Metabolic Diseases and Clinical Pharmacology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
Maja Cigrovski Berkovic, Department for Sport and Exercise Medicine, Faculty of Kinesiology University of Zagreb, Zagreb 10000, Croatia
Ivan Zajc, Ivan Salaric, Department of Oral Surgery, Clinical Hospital Dubrava, Zagreb 10000, Croatia
Ivan Zajc, Ivan Salaric, University of Zagreb School of Dental Medicine, Zagreb 10000, Croatia
Danko Müller, Iva Markota, Clinical Department of Pathology and Cytology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
Author contributions: Majic Tengg A designed the study, participated in the acquisition of data, and drafted the manuscript; Cigrovski Berković M made substantial contributions to the conception of the study and revised the manuscript critically; Zajc I, Salaric I, Müller D and Markota I participated in the acquisition of data and drafting of the manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed by the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maja Cigrovski Berkovic, MD, Adjunct Associate Professor, Department for Sport and Exercise Medicine, Faculty of Kinesiology University of Zagreb, Horvacanski zavoj 15, Zagreb 10000, Croatia. maja.cigrovskiberkovic@gmail.com
Received: October 18, 2023 Peer-review started: October 18, 2023 First decision: January 2, 2024 Revised: January 10, 2024 Accepted: February 5, 2024 Article in press: February 5, 2024 Published online: March 6, 2024
Abstract
Hyperparathyroidism (HPT) is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone (PTH), causing disturbances in calcium homeostasis. Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia. Brown tumors are rare, benign, tumor-like bone lesions, occurring in 1.5% to 4.5% of patients with HPT, as a complication of an uncontrolled disease pathway, and are nowadays rarely seen in clinical practice. The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass. Furthermore, it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion. The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium, phosphorus, and PTH. Although when present, brown tumor is quite pathognomonic for HPT, the histologic finding often suggests a giant cell tumor, while clinical presentation might suggest other more frequent pathologies such as metastatic tumors. Treatment of brown tumors frequently focuses on managing the underlying HPT, which can often lead to regression and resolution of the lesion, without the need for surgical intervention. However, in refractory cases or when dealing with large symptomatic lesions, surgical treatment may be necessary.
Core Tip: Clinicians should consider a brown tumor in hyperparathyroidism as a differential diagnosis of lytic bone lesions, after excluding more common causes such as metastatic carcinoma or multiple myeloma. A wide number of specialties should be aware of signs and symptoms of a brown tumor in hyperparathyroidism, including internal medicine specialists, orthopaedists, and radiologists, while dentists and oral surgeons should be aware of oral manifestations of systemic diseases.
