Brown tumor

The brown tumor is a bone lesion that

arises in settings of excess osteoclast
activity, such as hyperparathyroidism. It is
not a true neoplasm, as the term "tumor"
suggests; however, it may mimic a true
neoplasm. It most commonly affects the
maxilla and mandible, though any bone
may be affected.[1] Brown tumours are
radiolucent on x-ray.
 Brown tumor

Brown tumours of the hands in a patient with

hyperparathyroidism.

Pathology

Micrograph of a brown tumor (left of image). H&E

stain.

Brown tumours consist of fibrous tissue,

woven bone and supporting vasculature,
but no matrix. The osteoclasts consume
the trabecular bone that osteoblasts lay
down and this front of reparative bone
deposition followed by additional
resorption can expand beyond the usual
shape of the bone, involving the
periosteum thus causing bone pain. The
characteristic brown coloration results
from hemosiderin deposition into the
osteolytic cysts. Hemosiderin deposition
is not a distinctive feature of brown
tumors; it may also be seen in giant cell
tumors of the bone.[2][3]

Brown tumors may be rarely associated

with ectopic parathyroid adenomas[4] or
end stage renal osteodystrophy.[5]

Diagnosis
Histologically, it is impossible to
distinguish a Brown tumor of
hyperparathyroidism from other giant cell
lesions of bone. Rarely a focal collection
of osteoclasts (brown tumor) may occur in
relation to periosteum and be
indistinguishable from a peripheral giant
cell granuloma (giant cell epulis). The
possibility of hyperparathyroidism should
be considered in patients with recurrent or
multiple giant cell epulides. [6]

Radiographically, brown tumor may show

no detectable changes or a generalized
osteoporosis. Partial loss of lamina dura
around the teeth may occur but is not a
constant feature. Focal Lesions (Brown
Tumor) present as sharply defined, round
or oval radiolucent areas which may
appear multilocular. Such lesions occur
more frequently in mandible than maxilla
[7]

Treatment
Treatment of parathyroidism is required.
Parathyroidectomy usually leads to
spontaneous healing of Brown tumors.

Epidemiology
Age and gender have an effect on the
incidence of these lesions; they are more
prevalent in women than men (though still
common in both genders), and they
appear more frequently with age. Due to
the standard of medical care and
screening in developed countries, it is
increasingly rare for primary
hyperparathyroidism to present with
accompanying bone disease. This is not
the case in less developed nations,
however, and the two conditions are more
often seen together.[8]

See also
Osteitis fibrosa cystica

References
1. Meydan N, Barutca S, Guney E, et al.
(June 2006). "Brown tumors mimicking
bone metastases" . J Natl Med Assoc. 98
(6): 950–3. PMC 2569361 .
PMID 16775919 .
2. Aoki, J.; Moriya, K.; Yamashita, K.; Fujioka,
F.; Ishii, K.; Karakida, O.; Imai, S.; Sakai, F.; et
al. (1991). "Giant cell tumors of bone
containing large amounts of hemosiderin:
MR-pathologic correlation". J Comput
Assist Tomogr. 15 (6): 1024–7.
doi:10.1097/00004728-199111000-00023 .
PMID 1939753 .
3. Matsushige, T.; Nakaoka, M.; Yahara, K.;
Kagawa, K.; Miura, H.; Ohnuma, H.; Kurisu,
K. (Aug 2008). "Giant cell tumor of the
temporal bone with intratumoral
hemorrhage". J Clin Neurosci. 15 (8): 923–
7. doi:10.1016/j.jocn.2007.03.013 .
PMID 18554912 .
4. Sharma, Ravi; Mathan Mohan; R S
Neelakandan; D Siddharth (October 2013).
"An unusual case of brown tumor of
hyperparathyroidism associated with
ectopic parathyroid adenoma" . European
Journal of Dentistry. 7 (4): 500–503.
doi:10.4103/1305-7456.120657 . Retrieved
2013-10-28.
5. Nassar, George M.; Ayus, Juan Carlos
(1999-11-25). "Brown Tumor in End-Stage
Renal Disease" . New England Journal of
Medicine. 341 (22): 1652–1652.
doi:10.1056/nejm199911253412204 .
ISSN 0028-4793 . PMID 10572153 .
6. C. Johannessen, A. (2005). Oral
pathology, 4th edition (2005): Authors: J. V.
Soames and J. C. Southam. European
Journal of Orthodontics - EUR J
ORTHODONT. 27. 615-616.
10.1093/ejo/cji104.
7. C. Johannessen, A. (2005). Oral
pathology, 4th edition (2005): Authors: J. V.
Soames and J. C. Southam. European
Journal of Orthodontics - EUR J
ORTHODONT. 27. 615-616.
10.1093/ejo/cji104.
8. http://www.bonetumor.org/tumors-
disorder-metabolism/brown-tumor

External links
Classification ICD-9-CM: 252.01 • D

MeSH: D010002 •
DiseasesDB: 30721
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