PMC6051251_01
(a) Initial intraoral appearance of the brown tumor (right side). (b) Initial intraoral appearance of the brown tumor (left side). (c) Diagnostic panoramic radiography of bilateral brown tumors.
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Intraoral examination revealed pericoronitis and spontaneous bleeding from the periodontal pocket of the right mandibular second molar and swelling in the bilateral retromolar regions (Figures 1(a) and 1(b)). In the radiographic examination, bilateral not well-demarcated radiolucent lesions in the posterior regions of the mandible, measuring 4 x 3 x 3 cm on the right and 2.5 x 1.5 x 1.5 cm on the left, were observed (Figure 1(c)).
Microscopic finding from the parathyroid glands. (a) Right inferior paratiroid hyperplasia (H&E stain). (b) Right superior paratiroid hyperplasia (H&E stain). (c) Left inferior paratiroid hyperplasia (H&E stain). (d) Left superior paratiroid hyperplasia (H&E stain).
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As a result, parathyroid hyperplasia was diagnosed pathologically because of morphological and clinical evidence (Figure 2).
(a) Three months of follow-up: panoramic radiography of bilateral brown tumors. Notice to decreased radiolucency for the brown tumor in the left side of the mandible. (b) First year of follow up: panoramic radiography of bilateral brown tumors. Notice to decreased radiopacity for the brown tumor in the bilateral sides of the mandible.
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After being discharged from the hospital, the patient applied to our clinic for his follow-ups and bilateral regression of the lesions on the left side of mandible occurred spontaneously (Figures 3(a) and 3(b)).
(a) Six months of follow-up: panoramic radiography of bilateral brown tumors. Notice to decreased radiolucency for the brown tumor in the bilateral sides of the mandible. (b) Six months of follow-up: intraoral appearance of the brown tumor (right side). (c) Six months of follow-up: intraoral appearance of the brown tumor (left side). (d) Second year of follow-up: panoramic radiography of bilateral brown tumors. Notice not to observe recurrence for brown tumors in the bilateral sides of the mandible. (e) Second year of follow-up: intraoral appearance of the brown tumor (right side). (f) Second year of follow-up: intraoral appearance of the brown tumor (left side). (g) Fourth year of follow-up: panoramic radiography of bilateral brown tumors. (h) Fourth year of follow-up: intraoral appearance of the brown tumor (right side). (i) Fourth year of follow-up: intraoral appearance of the brown tumor (left side). Notice to the left mandibular third molar eruption is almost completed.
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In the radiographic examination, partial calcification of the lesions was observed after 6 months (Figure 4(a)). Also, after intraoral examination, spontaneous periodontal healing was uneventful (Figures 4(b) and 4(c)). Radiological and intraoral examinations were performed carefully in follow-ups for first and second years. (Figures 4(d)-4(f)). There was no evidence of recurrence at a 4-year follow-up, either radiographically or intraorally (Figures 4(g)-4(i)).