Brown tumor of hyperparathyroidism

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The location, expansion and radiolucent/radiopaque radiographic changes are consistent with brown tumor of hyperparathyroidism. The age and sex of the patient is not; neither is the histology.

Hyperparathyroidism is a condition caused by excessive production of parathyroid (PTH) hormone. It can be primary or secondary in type. Primary hyperparathyroidism is associated with an increase in PTH production, usually due to parathyroid gland hyperplasia, sometimes due to benign adenoma(s) of the gland(s) and rarely due to adenocarcinoma affecting one or more of the parathyroid glands (7-8). Brown tumor is more commonly associated with primary hyperparathyroidism. Secondary hyperparathyroidism is one of the sequelae of chronic renal disease (renal osteodystrophy); like the primary type, it is caused by increased parathyroid hormone (7-8). Primary hyperparathyroidism is three times more common in women and is more common in middle-aged patients. Clinically, both types may produce multiple bone lesions histologically indistinguishable from those produced by central giant cell granuloma (CGCG). It must be noted that CGCG is usually an isolated lesion, while hyperparathyroidism usually consists of generalized or multiple bony lesions affecting more than one bone or affecting multiple areas of one bone. The name ‘brown tumor’ reflects the chocolate-like color of the lesion. Primary hyperparathyroidism is associated with hypercalcemia, hypophosphatemia, and complications associated with hypercalcemia. Secondary hyperparathyroidism is usually associated with hypocalcemia but sometimes can have a normal calcium level with a high phosphate level (7-8). The signs and symptoms of hyperparathyroidism are designated by “stones, bones, moans and groans.” Radiographic features include generalized loss of bone density with loss of lamina dura and irregular radiolucent lesions (brown tumor), either single or multiple. The bone may have a ‘ground-glass’ appearance. Histopathologically, the brown tumor is made up of granulation tissue with aggregates of multinucleated giant cells, extravasated red blood cells and hemosiderin deposition. Treatment ranges from medical or surgical management of the underlying condition such as removal of hyperplastic or neoplastic glands, which should result in the resolution of the condition to renal dialysis and renal transplant. Enucleation and curettage of certain brown tumors is indicated.