44-year-old woman presented with left cheek swelling

 

Images

Doctor's Information

Name : Pooneh
Family : Dehghan
Affiliation :Radiology Department,Taleghani Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afarin Sadeghian

 

Case Section

Head & Neck Imaging

 

Patient's Information

Gender : Female
Age : 44

 

Clinical Summary

44-year-old woman presented with a 12-month hitory of generalized bone pain and 3-month history of left cheek swelling

 

Imaging Findings

Maxillofacial CT scan images reveal a well-defined,lobular,expansile soft-tissue mass in the left maxillary sinus extending through the nasal cavity and floor of the sinus.Expansion and wall erosion of the left maxillary sinus are visible.Due to the high serum calcium level and parathyroid sestamibi scintigraphy findings,the patient was diagnosed as primary hyperparathyroidism.Regarding to the patient history,areas of increase density within the mass could be due to subsequent bleeding in bone tissue versus after-treatment ossyfication.As well,well-defined purly lytic lesions in forearm radiograph of the patient are depicted.

 

Differential Diagnosis

1.Paranasal sinus malignancies, 2.Odontogenic tumors, 3.Metastatic carcinoma, 4.Fibrous dysplasia, 5.Giant cell reparative granuloma, 6.Aneurismal bone cysts, 7.Cherubism, 8.Plasma cell tumor

 

Final Diagnosis

Developing Brown tumor due to primary hyperparathyroidism

 

Discussion (Related Text)

Radiological differential diagnosis between a Brown tumor and other histological giant cell tumors is not simple. True giant cell tumors are more locally destructive than Brown tumors. Craniofacial fibrous dysplasia generally invades the bones of the face or the skull base, and is observed most commonly in young women. Reparative granulomas often arise in the alveolar arch of mandible or maxilla and affect children and young adults, generally females. Reparative granulomas are a reactive process, that is caused by trauma or inflammation.A reparative granuloma can be similar histologically and radiologically in appearance with a Brown tumor. The presence of HPT and hypercalcemia may be useful to differentiate these granulomas from Brown tumors. In the craniofacial region, aneurismal bone cyst is found more frequently in the mandible contains multiple septations and fluid-fluid level within the lesion. This lesion generally occurs in first 2 decades of life and mostly in females.Cherubism is a rare benign and familial disease of early childhood that is limited to the mandible and the maxilla. The radiologic appearance of this lesion is similar to a fibrous dysplasia.Paranasal sinus malignancies, odontogenic tumors, metastatic carcinoma, and plasma cell tumor have nonspecific radiological findings and generally occur in adulthood with equal frequency among males and females.

 

References

Proimos E, Chimona TS, Tamiolakis D, Tzanakakis MG, Papadakis CE. Brown tumor of the maxillary sinus in a patient with hyperparathyroidism: A case report. J Med Case Rep. 2009;3:7495.

 

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