236 - Mandibular Brown Tumor Linked to Tertiary Hyperparathyroidism: A Case Report

Introduction:  Brown tumors (BT) are rare, non-neoplastic, osteolytic lesions associated with hyperparathyroidism (HPT). BTs are rare in the craniofacial region. 

Case report: A nine-year-old female presented with significant cortical expansion of the anterior, right mandible with an intact mucosal surface and mobility of teeth (#s24-26). Medical history included end-stage renal disease secondary to hypoplastic kidneys, severe malnutrition, and tertiary HPT (2494pg/mL). Blood urea nitrogen (68mg/dL), calcium (12.3mg/dL), creatinine (4.1mg/dL) values were elevated. Panoramic radiograph revealed diffuse, ground-glass appearance of bone, consistent with renal osteodystrophy. CT imaging exhibited a well-circumscribed, osteolytic lesion of the mandibular, right, parasymphyseal region (11X13X12cm) with cortical thinning. Histopathologic examination demonstrated a giant cell lesion, consistent with BT. Patient received regular hemodialysis along with vitamin D supplements and calcimimetics.

Conclusion:  Management of BT ranges from conservative intralesional steroid injection to recontouring/excision. Control of chronic renal insufficiency and HPT can lead to partial or complete resolution of BT.

Identify Supporting Agency and Grant Number: Not applicable