Maxillary brown tumor in secondary hyperparathyroidism requiring urgent parathyroidectomy

Brown tumors are unusual but serious complications of renal osteodystrophy, and can be successfully treated by parathyroidectomy or by pharmacological treatment of hyperparathyroidism. Brown tumors in patients with severe hyp erparathyroidism. (HPT) secondary to renal failure have been increasingly r eported. We describe an unusual case of brown tumors at the maxillary bone and the seventh right rib, in a 57-year old man with a long history of hemo dialysis. The maxillary lesion caused serious local discomfort due to its r apid growth. In this setting, surgical total parathyroidectomy was chosen a s the most adequate therapeutic approach, given the previous unsatisfactory response to calcitriol. After successful parathyroidectomy, rapid healing was achieved with sclerosis of both brown tumors, as documented by serial c omputerized tomograms. In conclusion, although vitamin D therapy has been b eneficial in several cases of secondary hyperparathyroidism. complicated by brown tumors, we propose that whenever regression of the tumor bulk is urg ently needed, as in our case, parathyroidectomy should be the first treatme nt choice.