Brown tumor of the maxilla associated with primary hyperparathyroidism

Brown tumors represent the terminal stage of the remodeling processes during primary or secondary hyperparathyroidism. During the last three decades primary hyperparathyroidism has been recognized much more commonly and the increase has generally been attributed to the routine determination of calcium by new automated methods and the advent of new and more objective parathyroid hormone radioimmunoassay techniques. Early diagnosis and successful treatment of the disease have made clinical evidence of bone disease uncommon. While, the mandible is the most frequently involved bone in the head and neck region, maxillary involvement is extremely rare. A case of brown tumor on the maxilla associated with primary hyperparathyroidism is reported. This patient presented multiple skeletal lesions, which are uncommonly seen nowadays. The diagnosis was suggested by the clinical history and confirmed by biochemical, radiological and histopathological determinations. Excision of a parathyroid adenoma normalized the metabolic status. Excision of the maxillary mass led both histopathological confirmation of the disease and early masticator rehabilitation.     

Brown tumor of the maxilla due to secondary hyperparathyroidism.

The paper describes a patient with brown tumor of the maxilla caused by secondary hyperparathyroidism, and gives an account of pathophysiology and management.     

Clinical course in patients treated for primary hyperparathyroidism. Our results and review of the literature

Our aim was to verify the clinical improvement following surgery in patients diagnosed of primary hyperparathyroidism. Between april 1990 and november 2002 we have operated 83 patients with this diagnosis (12 men and 71 women). Before surgery, calcium and paratohormone (PTH) levels were measured, Together with clinical symptoms. We analysed the kind of surgery, AP results, complications and clinical evolution. In over 97% of cases we obtained a biochemical normalization after surgery, 96% of the patients with nephrolithiasis improved notoriously, being this the only statistically significant symptom (p < 0.01). The rest of symptoms also decreased following parathyroidectomy (p > 0.05).     

Osteoblastoma of the jaws. 2 cases and a review of the literature

The authors report on two cases of osteoblastoma: one of the maxilla in a twenty-two year old woman, the other of the mandible in a thirty-eight year old woman. In the two cases, the lesions were discovered after a systematic X-ray examination and they were treated by curettage. To date, sixty-seven cases of jawbone osteoblastoma and eleven cases of osteoid osteoma, a lesion which resembles and is perhaps similar to the osteoblastoma, have been reported in the literature. The authors develop the differential diagnosis and study the relationship between these two varieties of a same tumor or pseudo-tumor.     

Brown tumour of hyperparathyroidism in the mandible associated with atypical parathyroid adenoma

The brown tumour of hyperparathyroidism is a localized bone tumour and an uncommon manifestation of hyperparathyroidism. A 27-year-old woman presented with a mandibular 8 x 10 cm solid mass diagnosed as central giant cell granuloma. Chemical blood analysis revealed increased serum calcium levels of 12.46 mg/dL and the parathyroid hormone level was 124 pg/dL. The patient underwent surgery with removal of a parathyroid mass. Histologically, this parathyroid tissue was seen to be limited by a fibrous capsule with morphological features consistent with atypical parathyroid adenoma. The mandibular tumour has receded and the patient declined further procedures. This is the first case reported of brown tumour as the primary manifestation of an atypical parathyroid adenoma, a lesion that shares some features with parathyroid carcinoma without the unequivocal properties of malignancy.     

Brown bone tumor as the first manifestation of primary hyperparathyroidism

We report a clinical case of a 26 years old female who had a 2 years evolution chin tumour with hypercalcemia (11.8 mg/dl) and PTH (paratohormone) of 761 pg/ml. She underwent a CT scan and MRI of the mandible, as well as a biopsy followed by excision of the tumour by the maxilofacial surgeons. Our ENT Department asked for a Scintigraphy (Tc99s-mibi) and thoracic-cervical CT, which showed a lesion that turned out to be an adenoma of the lower right parathyroid gland after surgery and pathological examination. The patient suffered a Primary hyperparathyroidism that was the main stimulus for the Brown Tumour made up by macrophagos and multinuclear giant cells, being this the first manifestation of the metabolic disorder. This form of hyperparathyroidism is very rare in the clinic. We do a literature review to establish the differential diagnosis for such pathology.     

Secondary malignant tumors of the temporal bone. A histopathologic study and review of the world literature

Metastatic involvement of the temporal bone by malignant tumors is considered to be rare. The actual incidence of metastatic temporal bone tumors, however, is probably much higher than suggested by reports in the literature. The reason for this is that histologic studies are rarely performed on temporal bones in routine postmortem examinations of patients with possible metastatic disease. Also, in patients with multiple metastatic lesions, otologic complaints and signs may often be overshadowed by other more disabling symptoms. Twelve temporal bones were histopathologically examined from 6 patients who had metastatic temporal bone disease from various primaries and the results obtained in our present series of 6 cases were: 3 cases of hematogenous dissemination from a distant primary (a hepatic cell carcinoma, a bronchogenic squamous cell carcinoma, and an adenocarcinoma of unknown primary); 2 cases of direct invasion from adjacent head and neck tumors (squamous cell carcinomas of the eyelid and hypopharynx); and one case of diffuse metastatic leptomeningeal carcinomatosis (a transitional cell carcinoma of the renal pelvis). Among these, to our knowledge either hepatic cell carcinoma or renal pelvis carcinoma metastatic to the temporal bone has not been reported previously in the world literature. We reviewed the previously published reports of metastatic temporal bone tumors and found that there were 212 reported cases cited in the literature and that the most common sites of origin in order of frequency were breast, lung, pharynx, kidney, and prostate. Our temporal bone study and literature survey reveal that there are three distinct routes of tumor spread from the primaries to the temporal bone: 1) hematogenous dissemination from a distant primary, 2) direct neoplastic extension from adjacent areas, and 3) diffuse metastatic leptomeningeal carcinomatosis (DMLC). Our study also indicates that in most cases temporal bone symptoms appeared late in the course of disease, but in some cases the otologic symptoms were an initial sign of tumor, which was particularly conspicuous in the cases of DMLC. In the cases of hematogenous dissemination, the metastatic lesion tends to be overlooked or undiagnosed because occult metastases are relatively common or, when symptomatic, the otologic symptoms often resemble the features characterized by a severe form of mastoiditis. In the cases of direct neoplastic invasion, on the other hand, recognition of temporal bone involvement is usually simple since the primary disease is quite evident. Although metastatic temporal bone malignancies are rare, otologist should always be aware of existence of this disease entity in clinical practice.(ABSTRACT TRUNCATED AT 400 WORDS)     

Chondrocalcinosis (pseudogout) after surgical treatment of primary hyperparathyroidism. Report of a case and review of the literature

We are reporting the case of a 61-year-old female who developed an acute arthritis following parathyroidectomy because a primary hyperparathyroidism. The diagnosis of chondrocalcinosis or pseudogout was made by the clinical presentation, radiologic findings and demonstration of synovial fluid crystals of calcium pyrophosphate dihydrate. Rapid drops in serum calcium levels after removal of the adenoma may precipitate these acute articular inflammatory attacks that are not so uncommon as we can recognize if a bibliographic review about that association is performed.     

Amyloidosis of the larynx. A clinical case and literature review

The larynx is a rare site of deposition for amyloidosis. We are reporting the clinical case of a 73 years female with hoarseness of 2 years evolution due to a laryngeal mass which was informed as located primary amyloidosis after anatomopathologic exam (AP) and its extension study. A laryngeal microsurgery was performed and then we proceeded to send the patient to Internal Medicine Service with periodic controls by ORL. Surgery is the treatment of choice by microsurgery, laryngofissure or Laser with local excision. The prognosis of localized forms is better than systemic ones although recurrences are common and it is recommended a long-term follow-up. A bibliographic review about this pathology has been made.     

Infantile olfactory neuroblastoma. A clinicopathological study with review of the literature.

A case of olfactory neuroblastoma occurring in a 3-year-old girl is reported. The rarity of the lesion in early childhood is stressed and discussed with the clinico-pathological characteristics of the tumour, which are apparently more aggressive the younger the patient. Olfactory neuroblastoma should be considered as a possible diagnosis regardless of the age of the patient.     

Temporal bone chondroblastoma. A clinical case and literature review

We report a clinical case of a 31 year old male with a left temporal painful mass of six months evolution. After radiologic diagnosis, intraoperatory biopsy and surgical removal, the anatomopathological result confirmed the histology of chondroblatoma, with a satisfactory postoperative evolution. The chondroblastoma is a benign bone tumor typically located in the epiphysis of long bones and the temporal bone is an excepcional location as we have verified through a literature review.     

Brown tumor mimicking maxillary sinus mucocele as the first manifestation of primary hyperparathyroidism

We describe the first case of brown tumor mimicking a maxillary sinus mucocele as the first manifestation of the patient's primary hyperparathyroidism. A 34-year old woman presented with a 14 days history of elevation of the right orbit, retrobulbar pain and cheek anesthesia. The CT and MR evaluation showed a mass, initially described as mucocele of the right maxillary sinus. The laboratory studies revealed hyperparathyroidism. The patient underwent acute surgery, and the mass appeared clinically as mucocele. The histological examination of the resected lesion revealed changes representing either giant cell granuloma or brown tumor. The finding of hyperparathyroidism confirmed the diagnosis of brown tumor. To our knowledge, this is the first report of cystic brown tumor mimicking a mucocele of the maxillary sinus.     

Toxic nodular goitre associated with papillary thyroid carcinoma and primary hyperparathyroidism

The association of a toxic multinodular goitre with papillary thyroid carcinoma and primary hyperparathyroidism is very rare. Only one case is reported in the literature, we present the second one. It is a 51 year old woman, who initially presented with a toxic nodular goitre. The diagnosis of primary hyperparathyroidism was made following renal complications and the discovery of papillary thyroid carcinoma was incidental during the surgical treatment of parathyroid adenoma. Whilst the association of those three diseases is exceptional, the coexistence of any two of them is relatively frequent without any known common etiopathogenetis. It is recognised that hyperparathyroidism can be found in hyperthyroid patients, but the diagnosis of hyperparathyroidism in these cases is very difficult. The fortuitous discovery of papillary thyroid carcinoma during parathyroid surgery has already been reported but in most cases it is a microcarcinoma. In patients presenting with hyperthyroidism the risk of an associated carcinoma is generally felt to be negligeable. However, this associations is not rare. The association of primary hyperparathyroidism, hyperthyroidism and papillary carcinoma of the thyroid is rare. However, the authors suggest that the presence of any of the pathologies should trigger a search for the other two.     

Secondary laryngeal tumors. Report of seven cases with review of the literature

Laryngeal metastases are uncommon, particularly if we consider only secondary involvement from the remote primary neoplasm, via lymphohematogenous dissemination. In the 21-year period from 1966 to 1986, only seven cases of secondary laryngeal cancers were observed at the Department of Otolaryngology of Padua (Italy) University. A review of the world literature resulted in the identification of 113 previously reported cases. Cutaneous melanoma is the neoplasm most frequently metastasizing to the larynx, but adenocarcinoma may also often occur, especially from renal origin. A correct differential diagnosis from primary laryngeal cancer is most important. Identification of tumor location beneath intact mucosa, use of particular biochemical and histochemical stains, and electron microscopy may assist in establishing the presence of a metastatic growth. The prognosis is almost generally unfavorable because laryngeal involvement often occurs with metastases to other organs.     

Primary and secondary tumors of the facial nerve. A temporal bone study

Of 1400 temporal bones in the collection at the University of Minnesota, Minneapolis, 17 temporal bones from 15 patients were found to have tumors involving the facial nerve. The findings were as follows: one case of facial nerve schwannoma; two cases of invasion of the facial nerve by contiguous tumor; and 14 cases of metastatic tumors involving the facial nerve. Facial nerve paralysis was present in half of the cases (nine of 17). Facial nerve paralysis was present in the case of facial nerve schwannoma, in both cases of invasion of the facial nerve by contiguous tumor, and in six of 14 cases of metastatic tumors involving the facial nerve. The presence of the facial nerve paralysis correlated well with the degree of tumor infiltration into the nerve fibers and the segment of the tumor involvement in the facial nerve. In the patients with metastatic tumors, facial nerve paralysis was a sign of extensive intracranial tumor involvement and was usually accompanied by other cranial nerve palsies, most commonly involving the fifth nerve.     

Panendoscopy as a screening examination for simultaneous primary tumors in head and neck cancer: A prospective sequential study and review of the literature

A prospective panendoscopic evaluation comprising direct laryngoscopy, bronchoscopy, and esophagoscopy was conducted in 100 consecutively seen patients with untreated head and neck primary tumors. Of the patients, 16% (18% counting two third primary lesions found in the 16 patients) had synchronous primary malignant tumors of the aerodigestive tract. Eleven of the 16 patients had silent lesions found only by endoscopy, and 6 (6% of the total group) had lesions found only because the full panendoscopic protocol was followed. Those 6 tumors would not have been discovered as early by clinical examination or by symptom-only directed studies. The initial treatment plan in 7 patients was changed by the panenodscopic findings, This study verifies the high incidence of synchronous primary tumors in the head and neck areas that have been reported in retrospective studies, and suggests that an intensive, full panendoscopic work-up as a screening test in all patients with primary head and neck tumors can be conducted without increased morbidity and yields enough information to justify its cost.