Hyperparathyroidism revealed by brown tumors of the jaws: a retrospective case series

Brown tumors are rare osteolytic lesions resulting from prolonged excess of parathyroid hormone (PTH). Although they typically affect the axial skeleton, jaw involvement is uncommon and may represent the first manifestation of previously undiagnosed hyperparathyroidism. Because these lesions closely mimic other giant cell-rich jaw pathologies, accurate diagnosis requires careful clinicobiochemical correlation.

This retrospective single-center case series included three consecutive female patients treated between 2022 and 2023 for expansile giant cell-rich jaw lesions associated with elevated PTH levels. Clinical, radiological, biochemical, therapeutic, and follow-up data were analyzed descriptively.

Three patients, aged 22-60 years, presented with painless mandibular or maxillary swellings. Imaging showed radiolucent or mixed lesions with cortical expansion, including perforation in two cases. Histopathology revealed multinucleated giant cells within a fibrovascular stroma. Biochemical evaluation confirmed primary hyperparathyroidism in two patients and secondary hyperparathyroidism in one patient on hemodialysis. Parathyroidectomy led to lesion regression in the primary cases, while the secondary case was managed conservatively.

Jaw brown tumors may represent sentinel manifestations of systemic endocrine disease and can be easily misdiagnosed because of their radiological and histological resemblance to other giant cell lesions. Recognition of this association is crucial, as correction of the underlying endocrine disorder frequently leads to spontaneous lesion regression, avoiding unnecessary maxillofacial surgery.

Brown tumors of the jaws should be considered in the differential diagnosis of giant cell-rich jaw lesions. Early biochemical investigation and multidisciplinary management are essential to identify underlying hyperparathyroidism and ensure appropriate treatment.