A case of multiple brown tumors with primary hyperparathyroidism

Area of Science:

• Endocrinology
• Oncology
• Radiology

Background:

• Primary hyperparathyroidism (PHPT) is a condition characterized by excessive parathyroid hormone secretion, leading to hypercalcemia.
• Brown tumors are benign, osteolytic bone lesions that can occur in patients with prolonged PHPT due to bone resorption.
• Maxillary brown tumors are exceptionally rare, presenting diagnostic challenges.

Observation:

• A 52-year-old woman presented with rib pain, facial swelling, and a destructive osteolytic lesion in the left maxillary sinus.
• Imaging revealed multiple brown tumors in the maxilla, ribs, iliac bones, and pelvis.
• Laboratory results indicated hypercalcemia and hyperparathyroidism, with a parathyroid adenoma identified on imaging.

Findings:

• Biopsy confirmed the maxillary lesion as a brown tumor, characterized by new bone formation, giant cells, and hemosiderin deposits.
• Surgical removal of the parathyroid adenoma (parathyroidectomy) was performed.
• Post-operative imaging demonstrated significant reduction in the size of osteolytic lesions with calcification, alongside clinical improvement.

Implications:

• This case highlights the importance of considering PHPT in the differential diagnosis of osteolytic bone lesions, even when presenting in unusual locations like the maxilla.
• Effective management of the underlying parathyroid disorder can lead to substantial regression of brown tumors and symptom relief.
• Early diagnosis and treatment are crucial for preventing complications and improving patient outcomes in rare presentations of PHPT.