[PRIMARY AND SECONDARY HYPERPARATHYROIDISM PRESENTING AS BROWN TUMOR].

INTRODUCTION: Hyperparathyroidism (HPT) may lead to the formation of osteolytic lesions with giant granulomas. Giant cell lesions associated with HPT are known as brown tumor and represent an end stage complication of HPT. Brown tumors affect the mandible, clavicles, ribs and pelvis. Maxillary involvement is rare. We present two cases of brown tumor: the first is a case of primary HPT involving the maxilla and the second case is secondary HPT involving the mandible. Differential diagnosis, work up and methods of management of the jaw lesions are discussed.

Diffuse osteopenia and myelopathy in a puppy fed a diet composed of an organic premix and raw ground beef.

CASE DESCRIPTION: An 8-month-old Shetland Sheepdog was evaluated because of the sudden onset of signs of neck pain, collapse, and inability to rise. A cursory diet history indicated that the dog had been fed a raw meat-based diet. CLINICAL FINDINGS: Initial evaluation of the dog revealed small physical stature, thin body condition, and signs of cranial cervical myelopathy. Radiographically, diffuse osteopenia of all skeletal regions was identified; polyostotic deformities associated with fracture remodeling were observed in weight-bearing bones, along with an apparent floating dental arcade. Hypocalcemia and hypophosphatemia were detected via serum biochemical analyses. The dog's diet was imbalanced in macronutrients and macrominerals. TREATMENT AND OUTCOME: The dog received supportive care and treatment of medical complications; neurologic abnormalities improved rapidly without intervention. Dietary changes were implemented during hospitalization, and a long-term feeding regimen was established. Following discharge from the hospital, exercise restriction was continued at home. Serial follow-up evaluations, including quantitative bone density measurements, revealed that dietary changes were effective. After 7 months, the dog was clinically normal. CLINICAL RELEVANCE: In the dog of this report, vitamin D-dependent rickets type I and suspected nutritional secondary hyperparathyroidism developed following intake of a nutritionally incomplete and unbalanced diet. The raw meat-based, home-prepared diet fed to the dog was not feed-trial tested for any life stage by the Association of American Feed Control Officials, and its gross nutrient imbalance induced severe metabolic, orthopedic, and neurologic abnormalities. Inadvertent malnutrition can be avoided through proper diet assessment and by matching nutrient profiles with patients' nutritional needs.

[Mandibular fracture in a Lhasa Apso with secondary renal hyperparathyroidism]. / Fracture mandibulaire chez un Lhassa Apso avec hyperparathyroïdie secondaire rénale.

A Lhassa Apso is presented in emergency after having been injured by another dog. It was suffering from a mandibular fracture. The clinical exam revealed generalized and excessive mobility of the whole dentition. Radiographs showed generalized jaw bone demineralisation. A blood sample was analysed and revealed chronic renal disease. We came to the conclusion that this dog was suffering from secondary renal hyperparathyroidism. The hypocalcified bone was so thin that a slight trauma induced the mandibular fracture.

[Maxillary, buccal and dental expressions of hyperparathyroidisms]. / Manifestations maxillo-buccodentaires des hyperparathyroïdies.

States of chronic parathyroid hypersecretion, related to a primitive parathyroid abnormality (adenoma, hyperplasia), or to a cause of chronic calcipenia (renal failure, vitamin D deficiency…) have a major impact on bone remodeling, alveolodental structures. Thinning of the lamina dura, maxillary or mandibular brown tumors, giant cell epulis are the most emblematic signs of the primary hyperparathyroidism. Other expressions are related to genetic factors such as fibrous tumors of the jaw in conjunction with mutations in the gene coding for parafibromin.

Sagliker syndrome: first four cases in Bulgaria.

UNLABELLED: Sagliker syndrome characterized with uglifying the appearance of the face due to secondary hyperparathyroidism in patients with chronic renal failure receiving dialysis long time ago. The aim of the study was to identify any patients with Sagliker syndrome among the 78 patients receiving dialysis at the Dialysis ward, University Hospital "St. George", Plovdiv, Bulgaria. RESULTS: Four patients metthe criteria for Sagliker syndrome: chronic renal insufficiency, secondary hyperparathyroidism, short stature, severe changes in the skull and jaw that lead to festoon-like uglifying face, dental abnormalities, "brown" tumors, deformations of the phalanges of the fingers, psychological diseases and depression. CONCLUSION: The lack of control of the level of calcium and phosphorus in the blood in patients with chronic kidney disease leads to severe bone changes and psychological changes in patients with prolonged dialysis.

Mandibular mass in a child on hemodialysis.

We here with report a 13-year-old female patient on regular hemodialysis for the past five years who presented with a large mandibular mass. This was detected to be a brown tumor due to severe renal osteodystrophy as a complication of secondary hyperparathyroidism. The tumor did not regress even with intensive treatment with intravenous active vitamin D and needed surgical removal.

Bone scan in chronic dialysis patients with evidence of secondary hyperparathyroidism and renal osteodystrophy.

Bone scans in 13 of 14 patients on chronic dialysis were found to be abnormal. Symmetrical increased activity was noted in the calvarium, mandible, sternum, shoulders, vertebrae, and the distal aspects of the femur and tibia, as well as the patella. The scan abnormality is felt to be most likely the result of secondary hyperparathyroidism because of clinical and laboratory data, and, in four, confirmatory tissue diagnoses. The scan findings support the data of some earlier investigations on bone isotopic accretion in hyperparathyroidism. However, co-existing osteomalacia giving rise to abnormal activity in some of the patients cannot be excluded. Dihydrotachysterol may have minimized the extent of osteomalacia in these patients. Osteoporosis was probably present in some patients, but it appears differently on scan. Osteosclerosis was not detected on radiographic examination. Scan manifestations, especially mandibular activity, were pronounced and appeared earlier than the radiographic changes. The degree and extent of abnormal activity correlated with the length of dialysis and the level of alkaline phosphatase.

Osteodystrophia fibrosa in two guinea pigs.

Two adult guinea pigs were examined because they were lethargic and reluctant to walk. Additionally, I guinea pig had otitis media, and the other had dental malocclusion. Both guinea pigs had been fed a commercially available diet of cereals and pellets enriched with vitamin C and formulated for this species. Radiographically, the guinea pigs had coarse trabecular bone patterns, skeletal deformations, pathologic fractures, and polyarthritic degenerative joint disease. A double cortical line was also evident on several long bones, the pelvis, and the vertebrae. A diagnosis of osteopenia was confirmed by use of dual-energy x-ray absorptiometry. Analysis of a food sample fed to 1 guinea pig revealed calcium and phosphorus contents of 0.524 and 0.425%, respectively (Ca:P ratio, 1.23:1). Microscopic examination of bone tissue from both guinea pigs revealed severe fibrous osteodystrophy. Nutritional secondary hyperparathyroidism caused by calcium-phosphorus imbalance was considered to be the underlying cause of osteodystrophia fibrosa in both guinea pigs.

Central giant cell granuloma.

Central giant cell granuloma, a fibro-osseous lesion, is more commonly found in the mandible and mainly in children and young adults. The lesion, which has a greater incidence in females, may be uni or multilocular. On the basis of clinical, radiological and histologic features, central giant cell granulomas can be classified as "non-aggressive" or "aggressive". Management involves surgical removal and in most cases the dentition can be maintained. Three cases of central giant cell granuloma are reported and they illustrate clinical features of the lesion, how differential diagnosis can be assisted by ORAD (a special software program), treatment, and the importance of recall examinations.

[Clues to recognition of kidney disease in archaeologic record: characteristics and occurrence of leontiasis ossium]. / Alterazioni scheletriche in corso di malattie renali croniche: caratteristiche e frequenza della leontiasi ossea e sua importanza in osteoarcheologia.

The possible osseous effect of kidney dysfunction was evaluated in a modern skeletal population for future use in assessment of archaeologic samples. Frequency and distribution on the bones of cysts, articular surface alterations, subperiosteal resorption, porosity, osteochondritis, digital tuft alteration and periosteal reaction were recorded in 94 individuals with known kidney failure in the Hamann-Todd collection. Independent radiologic analysis was also pursued. The results were compared with a control sample. The pattern of joint surface alteration and periosteal reaction may facilitate recognition of chronic renal disease in the osseous record. Subtle manifestations of leontiasis ossium are present in the form of cranial thickening and increased cranial size and weight, but teeth spacing are rare. Pseudo osteomatous lesions are common. This study perhaps explains the apparent rarity of actual leontiasis ossium.

[Outlines of K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease].

Recently "K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease" was published. It consists of sixteen precise guidelines which cover the wide range of this field. It is expected that these guidelines contribute ESRD treatment in Japan in spite of some differences in medical practice for dialysis therapy between Japan and the United States. This article briefly summarizes the outlines of these guidelines.

Pneumosinus dilatans multiplex associated with hormonal imbalance.

Pneumosinus dilatans describes an abnormal dilation of one or more paranasal sinuses without radiological evidence of localised bone destruction, hyperostosis or mucous membrane thickening. Dilation of mastoid air cells also occurs rarely along with involvement of paranasal sinuses. This rare combination of unknown aetiology was reported in two cases in the literature and termed 'Pneumosinus Dilatans Multiplex' (PSDM). It is usually asymptomatic, and is detected incidentally on plain radiography, CT or MRI. If left untreated, it can further erode the bone leading to complications such as facial asymmetry, neurological disorders and pathological fractures. The aetiology of the condition remains obscure. Various hypotheses proposed are the presence of gas-forming microorganisms, spontaneous drainage of a mucocele, the presence of a one-way valve, dysregulation of hormonal levels leading to a disturbance of osteoblastic and osteoclastic activity. This paper describes a case of PSDM possibly secondary to hormonal disturbance.

Brown tumor of hyperparathyroidism masquerading as central giant cell granuloma in a renal transplant recipient: a case report.

The brown tumor of hyperparathyroidism is histologically identical to the central giant cell granuloma (CGCG), but these lesions can be differentiated based on history and laboratory findings. Herein we have reported a 46-year-old renal transplant recipient in whom brown tumors of hyperparathyroidism were detected several years following renal transplantation. The lesions initially masqueraded as a CGCG with an intranasal mass and ethmoid bone involvement at 7-years posttransplantation, for which surgical resection had been performed. Six years later, she developed multiple expansile bony lesions of the chest wall with histologic features of multinucleated giant cells. A markedly elevated parathyroid hormone level led us to make a diagnosis of brown tumor of hyperparathyroidism. Hence, we propose that clinicians consider brown tumor of hyperparathyroidism to be a potential cause of giant cell lesions among renal transplant recipients. Moreover, careful follow-up examinations are required for such patients to make a timely and accurate diagnosis.

[New studies and considerations on the pathology of the primate skull. A contribution to the "Gundu" problem]. / Neue Beobachtungen und Uberlegungen zur Pathologie des Primatenschädels. Ein Beitrag zur "Gundu"-Frage.

The problem of 'Gundu' in primates is discussed. Cases of so-called 'Gundu' in the literature, two cases in Gorilla and one in Lagothrix, are dealt with. Histological and X-ray techniques are used. One case (Lagothrix) represents the so-called simian bone disease, which is metabolic disorder and is due to a secondary nutritional hyperparathyroidism. The other two cases (Gorilla) show symmetrical bony tumors of the maxilla. The origin is uncertain. Gundu, Paget's disease and primary hyperparathyroidism Recklinghausen have not been observed in primates so far.

[Radiologic diagnosis in hyperparathyroidism]. / Radiologische Diagnostik beim Hyperparathyreoidismus.

The most important radiologically detectable effects of the primary and secondary hyperparathyroidism of the skeletal system and the periarticular soft tissue structures are presented. In the following sensitivity and specificity of radiological imaging--sonography, scintigraphy, computed tomography, magnetic resonance imaging, arteriography and selective venous sampling--in the preoperative diagnostic of the parathyroid adenomas are discussed. Therefore, radiological imaging can be omitted before primary surgery. It was only in secondary surgery that radiological process proved useful and a guide during surgical intervention.

[Giant-cell reparative granuloma: a case report]. / Granulome réparateur central à cellules géantes (GRCCG).

We report a case of giant-cell granuloma located in the maxilla of a 9-year-old child. The pathogenesis of giant-cell reparative granuloma (GCRG) remains obscure. Radiological features are variable. Radiolucency or well or ill-defined uni-or multilocular aspects with trabeculations can be observed. Symptoms of compression on the adjacent tooth's root and pathology findings confirm the diagnosis. Curettage is effective and recurrence is rare.