Surgical management of Brown Tumor of the Mandible Associated with Ectopic Primary Hyperparathyroidism

Brown tumors are considered one of the most pathognomonic skeletal changes that accompany primary hyperparathyroidism (PHPT). It results from excessive secretion of parathyroid hormone (parathormone or PTH). The mandible is the most involved facial bone by brown tumor. Ectopic located parathyroid adenoma is uncommon, and thus, its diagnosis and management can sometimes be challenging. Difficulties in locating the mediastinum ectopic parathyroid adenoma may delay the diagnosis and subsequent surgery. A case of brown tumor of the mandible associated with ectopic mediastinum PHPT was reported. The tumor had caused facial asymmetry, open bite and bleeding. Laboratory tests revealed that the patient had hyperparathyroidism. Histopathological examination from the lesion revealed the presence of a giant cell tumor. Diagnostic imaging including the utility of 99mc Tcsestamibi parathyroid scan denoted the presence of an ectopicmediastinum parathyroid adenoma. Parathyroidectomy and surgical removal of the brown tumor performed. Early diagnosis and successful treatment of PHPT have made clinical evidence of bone disease uncommon. Surgical removal of brown tumor of the mandible should be considered if the mass of serious facial deformity, lethal outcome and if the mass does not regress after parathyroidectomy. Finally the need to consider hyperparathyroidism (HPT) in the initial differential diagnosis of bony lesions of the jaw especially cases with histopathological features of giant cell tumor. [Basma G Moussa Ashraf Helal. Surgical management of Brown Tumor of the Mandible Associated with Ectopic Primary Hyperparathyroidism. Biomedicine and Nursing 2015;1(1):80-87]. ISSN 2379-8211. http://www.nbmedicine.org. 15. doi:10.7537/marsbnj010115.15