Peripheral giant cells granuloma as a rare early manifestation of primary hyperparathyroidism

Abstract

Primary hyperparathyroidism occurs due to parathyroid adenoma, which as initial presentation in most cases includes recurrent nephrolithiasis (10-25%). Giant cell tumors (GDD) also called osteoclastomas or brown tumors affect the second decade of life and are currently a rare manifestation of primary hyperthyroidism. The incidence of lesion appearance in the maxillary bones is 4.5%. We presented the case of a 36 year old female patient with history of hypertension, who developed an increase in volume in the right maxillary region of 4×3 cm, with incapability of complete occlusion of dental arch, solid dysphagia, biopsy was performed with peripheral giant cells granuloma as a result, PTH serum levels were requested, with result of 1175 pg/ml and serum calcium of 13.24 mg/dl. Parathyroid gammagram was performed with hyperfunctioning parathyroid tissue. Patient underwent a selective parathyroidectomy. She had an adequate postoperative evolution and was discharged without complications. The patient had adequate follow up by head and neck surgery in external consultation, serum calcium 7.66 mg/dl, decrease of volume in right maxillary region to 3×3 cm; pathology report with parathyroid adenoma. Surgical treatment of brown tumor is still pending by the maxillofacial surgery department.