Brown tumor due to hyperparathyroidism secondary to chronic kidney disease: A clinical case
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Keywords
Osteolysis, Hyperparathyroidism, Secondary, Renal Insufficiency, Chronic, Adolescent, Granuloma, Giant Cell
Abstract
Background: Brown tumors are aggressive and lethal due to their osteolytic capacity. They occur in 1.5 to 1.7% of patients with secondary hyperparathyroidism. The objective is to present the unusual case of an adolescent with stage V chronic kidney disease (CKD) who developed a brown tumor at the angle of the mandible due to secondary hyperparathyroidism.
Clinical case: A 14-year-old female with stage V CKD of 4 months of evolution. She came to the consultation because 3 months earlier she had developed a tumor at the level of the lower left second molar which caused an increase in volume in the cheek and ipsilateral facial asymmetry, as well as occasional mild bleeding due to biting. The tumor was identified at the level of the aforementioned molar, measuring 3 cm in diameter, firm, non-mobile, and not painful to palpation; it also showed enlargement of the ipsilateral mandibular angle. Computed tomography of the mandibular angle showed a locally aggressive, solid lesion that expanded the cortex and eroded to extrude into soft tissue. A biopsy identified giant cell granuloma. Secondary hyperparathyroidism and subclinical hypothyroidism were detected; pharmacological management was initiated, with an adequate tumor’s response.
Conclusions: Brown tumors are very rare as the first clinical manifestation of secondary hyperparathyroidism in pediatric population. If a giant cell tumor is present in patients with CKD, brown tumor should be ruled out.
References
1. Jamshidi R, Egan JC. Pediatric parathyroid disease. Semin Pediatr Surg. 2020;29(3):150923. doi: 10.1016/j.sempedsurg.2020.150923
2. Zhang LX, Zhang B, Liu XY, et al. Advances in the treatment of secondary and tertiary hyperparathyroidism. Front Endocrinol (Lausanne). 2022;13:1059828. doi: 10.3389/fendo.2022.1059828
3. Guilmette J, Sadow PM. Parathyroid Pathology. Surg Pathol Clin. 2019;12(4):1007-19. doi: 10.1016/j.path.2019.08.006
4. Fernández Camblor C, Melgosa Hijosa M. Enfermedad renal crónica (ERC) en la infancia: diagnóstico y tratamiento. Protoc Diagn Ter Pediatr. 2022;1:347-57.
5. Bovera J, Aranaa C, Ureña P, et al. Hyporesponsiveness or resistance to the action of parathyroid hormone in chronic kidney disease. Revista de la Sociedad Española de Nefrología. 2021;41(5):514-28.
6. Moreta Colcha HS, Paucar Llapapasca SD, Delgado Angamarca MJ, et al. Hiperparatiroidismo secundario insuficiencia renal. RECIMUNDO. 2020;4(4): 282-90. doi: 10.26820/recimundo/4.(4)
7. Alcaide L, Hernández García E, Reyes LS. Hiperparatiroidismo secundario. Actualización y revisión bibliográfica. Cir Andal. 2020; 31(3):294-99. doi: 10.37351/2020313.11
8. Padilla Rosas M, Mendoza López AL, Romero Becerra A, et al. Patient with chronic kidney disease and secondary hyperparathyroidism. Case report. ORAL. 2018;19(61):1664-6.
9. Gallana Álvarez S, Salazar Fernandez CI, Avellá Vecino F, et al. Tumor pardo maxilar: Elemento diagnóstico de hiperparatiroidismo primario. Rev Esp Cir Oral y Maxilofac. 2005; 27(4):225-30.
10. Dionisi MP, Quintero MA, Quintero ML, et al. Tumor pardo multifocal: reporte de caso en hemodiálisis crónica. Rev Nefrol Dial Traspl.2022;42(2):170-8. Disponible en: https://www.revistarenal.org.ar/index.php/rndt/article/view/797
11. Xu B, Yu J, Lu Y, et al. Primary hyperparathyroidism presenting as a brown tumor in the mandible: a case report. BMC Endocr Disord. 2020;20(1):6. doi: 10.1186/s12902-019-0480-2
12. Del Río-Prado AF, González-López JA, Peña-Ruelas CI. Múltiples tumores pardos en una paciente con hiperparatiroidismo secundario grave. Med Int Mex. 2017;33(2):291-5. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0186-48662017000200291&lng=es
13. Alemán Iñiguez JM, Mora Bravo F, Bravo Aguilar C. Rara localización de tumor pardo en insuficiencia renal crónica. Reporte de un caso pediátrico y actualización. Rev Port Endocrinol Diabetes Metab. 2016;11(2):220-7.
14. Falcón DE, Navarro López JSA, Sassari Sandoval MG, et al. Tumor pardo en maxilar superior como signo clínico de presentación del hiperparatiroidismo terciario en pediatría. Caso clínico patológico. ORAL. 2019;20(63):1732-7.
15. Webster AC, Nagler EV, Morton RL, et al. Chronic Kidney Disease. Lancet. 2017;389(10075):1238-52. doi: 10.1016/S0140-6736(16)32064-5
16. Argaiz ER, Morales-Juárez L, Razo C, et al. The burden of chronic kidney disease in Mexico: data analysis based on the Global Burden of Disease 2021 study. Gac Med Mex. 2023;159(6):487-93. doi: 10.24875/GMM.M24000830
17. Méndez-Durán A, Duque-Molina C, Teva-Luna R, et al. Renoprotección. A propósito del Día Mundial del Riñón. Rev Med Inst Mex Seguro Soc. 2023;61(5):631-7. doi: 10.5281/zenodo.8316457
18. López-Heydeck SM, Robles-Navarro JB, Montenegro-Morales LP, et al. Factores de riesgo y de estilo de vida asociados a enfermedad renal crónica. Rev Med Inst Mex Seguro Soc. 2020;58(3):305-16. doi: 10.24875/RMIMSS.M20000035
19. Mondal A, Sarkar P, Bhattacharjee T, et al. A Large Brown Tumor of Mandible as First Manifestation of Hyperparathyroidism. J Pharm Bioallied Sci. 2024;16(Suppl 4):S3679-S3682. doi: 10.4103/jpbs.jpbs_357_24
20. Majic Tengg A, Cigrovski Berkovic M, Zajc I, et al. Expect the unexpected: Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism. World J Clin Cases. 2024;12(7):1200-4. doi: 10.12998/wjcc.v12.i7.1200
21. Liu Z, Yang H, Tan H, et al. Brown tumor of the cervical spine with primary hyperparathyroidism: A case report and literature review. Medicine (Baltimore). 2023;102(6):e32768. doi: 10.1097/MD.0000000000032768
22. Singh S, Padhy SK, Mohapatra SS, et al. Chronic Kidney Disease Presenting With Brown Tumors in the Mandible. Cureus. 2022;14(4):e23985. doi: 10.7759/cureus.23985
23. Majumdar S, Uppala D, Kotina S, et al. Brown tumor of hyperparathyroidism with multiple lesions. J Oral Maxillofac Pathol. 2022;26(Suppl 1):S111-5. doi: 10.4103/jomfp.jomfp_409_20
24. Atmis B, Cevizli D, Melek E, et al. Proptosis in a child with chronic kidney disease: Questions. Pediatr Nephrol. 2020;35(5):787-8. doi: 10.1007/s00467-019-04422-4
25. Shavlokhova V, Goeppert B, Gaida MM, et al. Mandibular Brown Tumor as a Result of Secondary Hyperparathyroidism: A Case Report with 5 Years Follow-Up and Review of the Literature. Int J Environ Res Public Health. 2021;18(14):7370. doi: 10.3390/ijerph18147370
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