Imaging case study of the month Brown tumor of the palate in a patient with primary hyperparathyroidism

The manifestation of primary hyperparathyroidism as skeletal disease has nearly disappeared in the last 2 decades. Cases are now most often diagnosed by the incidental finding of asymptomatic hypercalcemia. Improved screening techniques have made clinical evidence of bone disease uncommon. Classic radiographic findings of subperiosteal bone resorption, bone cysts, brown tumors, and generalized osteopenia now occur in fewer than 5% of cases.(1-3) Brown tumors may occur in the head and neck, with the mandible being the most frequent site. Involvement of the maxilla is exceptionally rare.(4,5) A brown tumor most commonly presents as a slowly enlarging, painful mass. These tumors can be locally aggressive, but do not possess metastatic potential. Histologically, they are similar to giant cell lesions. Treatment initially focuses on correction of the hypercalcemic state. Brown tumors frequently show regression after normocalcemia is achieved, but surgical resection is necessary in some patients. We present a case of a brown tumor involving the hard palate and nasal cavity in a young woman.