Brown Tumors of the Jaws: A Retrospective Study

Abstract

Objectives: (1) Describe the clinical spectrum, imaging features, management, and outcome of brown tumors (BT) of the jaws. (2) Determine via a literature review the facts and controversies around the characteristics and management of this lesion.

Materials and methods: Our study was approved by the institutional committee of Sahloul University Hospital in accordance with the ethical standards of the Declaration of Helsinki. Sixteen patients with BT in the context of a primary, secondary, and tertiary hyperparathyroidism were treated and followed up during their recovery.

Results: This study reports 16 patients with a mean age of 48 years old. Brown tumor lesions were associated with primary hyperparathyroidism in 6 cases (38%), secondary hyperparathyroidism to chronic kidney failure in 5 cases (31%), and tertiary hyperparathyroidism in the context of a long lasting CRI in 5 cases. Their location was maxillary in 7 cases, mandibular in 5 cases, and bimaxillary in 4 cases. The treatment consisted of parathyroidectomy in 13 patients, maxillary resection in 3 cases, and vitamin D treatment in 2 cases. Favorable outcomes, characterized by tumor regression, were reported in 9 cases, whereas unfavorable evolution was observed among 7 patients.

Conclusion: Parathyroidectomy is the gold standard treatment for primary hyperparathyroidism. It resulted in a total regression in all our cases. Regarding secondary hyperparathyroidism, blood screening and chronic renal insufficiency follow-up are critically valuable to detect this condition at an early stage, hence increasing the success rate of brown tumor regression. Our secondary and tertiary hyperparathyroidism results were miscellaneous; although it is important to emphasize the importance of the chronic renal insufficiency management to ensure a success.

Clinical relevance: Brown tumors should be included in the differential diagnosis of giant cell lesions. Parathyroidectomy is usually sufficient to induce the total regression of the lesion in primary hyperparathyroidism cases. A more delicate approach is needed regarding secondary hyperparathyroidism. Meticulous control of chronic renal insufficiency is mandatory in addition to parathyroidectomy.

Keywords: Osteitis fibrosa cystica; brown tumors; hyperparathyroidism; parathyroidectomy.

Figure 1.

Intraoral view of a mandible swelling initially (a) and after etiological treamtent (b) showing a total regression of the lesion.

Figure 2.

Extraoral profile view (a) and intraoral view (b) of a symphyseal swelling covered by ulcerated mucosa before treatment. Extraoral profile view (c) and intraoral view (d) 3 months following the etiological treatment showing a total regression (Case Nº 4).

Figure 3.

Axial view of a mandibular CT scan in parenchymal window showing a substantial, well limited and homogeneous osteolytic lesion of the symphysis, presenting a tissue density and swelling the cortical area.

Figure 4.

Axial view of a CT scan showing a frosted glass image in the mandible.

Figure 5.

Parenchymal window of a facial mass’s CT scan in a frontal (a) and axial (b) views showing the multilocular aspect of a mandibular lesion.

Figure 6.

Extraoral view showing the widest lesion of our study (8 cm diameter) presenting a bilateral maxillary location.