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Facial bone brown tumors - primary hyperparathyroidism

Case contributed by Doaa Khedr Mohamed Khedr
Diagnosis certain

Presentation

The patient presented with progressive facial disfigurement with a history of partial right maxillectomy 15 years ago.

Patient Data

Age: 55 years
Gender: Female

Few well-defined expansile multi-locular osteolytic lesions with cortical expansion and focal areas of interruption are seen affecting both mandibular rami, right maxilla, and left anterior ethmoidal bones. There is no associated periosteal reaction, calcification, or extra-osseous soft tissue component. They show no significant enhancement.

The left anterior ethmoidal sinus lesion is seen extending to the left compartment of the frontal sinus.

Diffuse altered density of the scanned bone, showing mixed sclerotic and lytic density. Osteolytic lesion is seen in the body of C2 and C3 vertebrae

Mild mucosal thickening of the left maxillary sinus.

Mucosal thickening associated with hyperdense foci is seen partially filling the right sphenoidal sinus.. impressive of chronic sinusitis

Pathology

Trucut biopsy from right maxillary sinus suspicious mass.

Microscopic Examination: Sections prepared reveal fibrous stroma containing clusters of giant cells together with hemosiderin & extravasated RBCs. Snips of skin & muscle were detected.

Diagnosis: Giant cell containing reactive lesion consistent with giant cell reparative granuloma. Correlation with clinical, radiological & laboratory data for the possibility of hyperparathyroidism.

Dr Shaimaa Mohamed Ebrahim, Pathology Department, Mansoura Faculty of Medicine.

Case Discussion

The serum parathormone of the patient was 796.7 Pg/mL. The patient had neck scintigraphy that revealed right parathyroid uptake. She underwent complete surgical resection and histopathological confirmation of parathyroid adenoma.

Sections prepared revealed well-circumscribed nodule with thin fibrous capsule formed mainly of nodules of clear cells with well-defined cell borders and rounded nuclei with no atypia or pleomorphism. Final diagnosis: parathyroid adenoma (clear cell type).

The main radiological sign of hyperparathyroidism is bone resorption with diffuse osteopenia.

Considering the patient's age, the first differential diagnosis of this case was metastasis followed by other lytic bone lesions causes.

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