Brown tumours: widespread involvement of multiple maxillofacial bones and cervical spine.

To cite: Gadhia T, Adegun OK, Fortune F. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014207140 DESCRIPTION Brown tumours are sequelae of abnormal bone metabolism in hyperparathyroidism. Primary, secondary and tertiary hyperparathyroidism are causative with most cases of the secondary type. 3 This article highlights Brown tumours of bones rarely reported in literature. We report a case of a 34-year-old woman with difficulty in eating and speaking as a result of a reduced mouth space. Medical history revealed end-stage renal disease for which she underwent haemodialysis three times a week. Physical examination showed firm bony expansions on both maxillary buccal shelves, anterior palate, and labial and lingual plates of the mandible. CT imaging of the head and neck demonstrated widespread groundglass appearance of the dental arches, facial bones and cervical spine (figures 1 and 2). In the maxilla, multilocular and expansile lesions involving the right and left buccal shelves are seen, with the latter more prominent (figure 1A). In the mandible, multiple destructive lesions (figure 1C), bony expansions of the labial and lingual plates and prominent anterior interdental spacing (figure 1B, C) were observed. Loss of lamina dura around the lower canine root and a moth-eaten appearance in the gonial area are shown in figure 2B. Unusually, multiple concurrent osteolytic lesions of the zygomatic complexes (figure 2A, C) and cervical spine (figure 2B, C), both infrequently reported, were also identified. Biochemical investigations showed raised urea, creatinine, alkaline phosphatase and serum parathyroid hormone (2007 pg/mL; normal 16–69 pg/mL). These findings are consistent with Brown tumours in hyperparathyroidism secondary to end-stage renal disease.