Giant Cell Lesions Associated with Primary Hyperparathyroidism

Abstract

Aims and Objective To evaluate the prevalence, clinical features, diagnostic laboratory values and treatment outcome of giant cell lesions (brown tumors) associated with primary hyperparathyroidism (PHPT) in oral and maxillofacial region. Study Design A 5 year retrospective data was analyzed wherein all histopathologically proven cases of giant cell lesions involving oral and maxillofacial region were evaluated. Out of these cases, those associated with PHPT were tabulated. Correlation was established with other concomitant clinical features and also with the laboratory values of altered serum calcium, phosphate, alkaline phosphate and parathormone. Follow up of these cases after the correction of PHPT was also noted. Result Out of 85 cases of histopathologically proven giant cell lesions, five cases were associated with PHPT. There was involvement of maxilla and mandible in one case each. Only frontal bone was involved in two cases. Fifth case had multiple lytic lesions in maxilla and frontal bone. All patients consistently showed very high values of alkaline phosphate and parathormone. Hypercalcemia and hypophosphatemia was noted in four cases. All cases showed regression of the lytic lesion after parathyroidectomy obviating the need for surgical excision of the jaw lesions.Conclusion Giant cell lesions (brown tumors) associated with PHPT in oral and maxillofacial region are rare clinical entities. The prevalence of PHPT associated giant cell lesions is 5.9 %. They are clinically, radiologically and histopathologically similar to any other peripheral or central giant cell tumor. Relevant history may alert the clinician and altered biochemical values may help in correlating the oral and maxillofacial findings with the underlying systemic disease. At times, the brown tumor maybe the only presenting sign leading to the diagnosis of PHPT.

Brown tumor of multiple facial bones associated with primary hyperparathyroidism

“…Although brown tumors have been reported extensively, only 4.5% of reported cases have involved the facial bones. [ 5 ] Tumors of the maxillofacial region are more likely to affect women than men, with a reported female: male ratio of approximately 1.7:1 and mean age at diagnosis of 34 years. [ 6 ] Maxillofacial tumors usually involve solitary bones, with the mandible being the most frequently affected.…”

Kemiğin dev hücreli tümörü taklit eden primer hiperparatiroidizme bağlı brown tümörü

“…PET/BT incelemesinde osteoklast benzeri dev hücrelerin varlığı ve makrofajlarda metabolizma artışına bağlı kemik metaztazını taklit edebilen FDG tutulumu izlenebilir. [8] Olgumuzda da görüldüğü üzere PET/ BT incelemesinin brown tümörü tanısında yeri sınırlı olmasına rağmen tedaviye cevabın takibinde önemli role sahiptir. Dev hücreli tümör tanısı alan hastaların gereksiz tetkiklerin önlenmesi ve tanıda gecikilmemesi adına öncelikle hiperparatiroidizm açısından incelenmesi önerilir.…”

“…Dev hücreli tümör tanısı alan hastaların gereksiz tetkiklerin önlenmesi ve tanıda gecikilmemesi adına öncelikle hiperparatiroidizm açısından incelenmesi önerilir. [8] Dev hücreli tümörlerin tedavisinde lezyonun eksizyonu primer tedavi yöntemidir. Fakat hiperparatiroidizme bağlı brown tümörü olgularında lezyonun eksizyonu yerine paratiroidektomi önerilmektedir.…”

“…[9] Literatürde çeşitli olgu sunumlarında paratiroidektomi sonrası PTH seviyelerinin normale dönmesini takiben hem semptomlarda hemde kemik lezyonlarında belirgin düzelme olduğu gösterilmiştir. [8,9] Olgumuzda da kemik lezyonlarına herhangi bir cerrahi eksizyon uygulanmayan hastanın paratiroidektomi sonrası takiplerinde semptomlarında belirgin düzelme izlendi. Sonuç olarak, brown tümörlerinin radyolojik ve histopatolojik incelemelerde kemiğin malign lezyonlarını taklit edebileceği akılda tutulmalıdır.…”

Coexistence of hyperparathyroidism and peripheral giant cell granuloma of the jaw: A rare case report

“…The odontogenic tissues and jawbones are also affected as a systemic manifestation of PHPT. [ 8 ] The occurrence of both PGCG and PHPT is more in females. [ 9 ] The ratio of female and male for PGCC is 2:1 and for PHPT is 3:1.…”