Abstract

Brown tumors are rare benign osteolytic lesions resulting from excessive osteoclastic activity in the setting of hyperparathyroidism. They occur in approximately 1.5–4.5% of patients with primary or secondary hyperparathyroidism and may occasionally represent the initial manifestation of the disease. We report the case of a 31-year-old woman who presented with progressive left facial swelling and mandibular deformity. Laboratory investigations revealed severe primary hyperparathyroidism with marked hypercalcemia and significantly elevated parathyroid hormone levels.
Computed tomography demonstrated multifocal osteolytic lesions involving both the maxilla and mandible, associated with diffuse craniofacial demineralization displaying a characteristic “salt-and-pepper” appearance. Additional lesions were identified in the ribs and humerus, together with a right inferior parathyroid adenoma. The diagnosis of multifocal brown tumors secondary to primary hyperparathyroidism was established based on the combination of clinical, biochemical, and imaging findings. Surgical excision of the adenoma resulted in normalization of biochemical parameters and progressive regression of the mandibular lesion.
This case is noteworthy because of the unusual coexistence of multiple maxillomandibular brown tumors with multifocal skeletal involvement in a young patient. It highlights the pivotal role of imaging in suggesting the diagnosis and preventing misinterpretation as metastatic bone disease or other giant-cell lesions.

Key words: brown tumors hyperparathyroidism adenoma mandibular osteolytic