PMC4979328_01
Full-face photograph showing a generally debilitated state
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F1
The patient was in a generally debilitated state, making hemodialysis sessions 3 times a week [Figure 1].
Intraoral photograph showing anterior palatal enlargement. Note displacement of the teeth in the related area
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F2
Intraoral inspection revealed an asymptomatic swelling in the anterior palate with a bony consistency, with crackling on some points, measuring approximately 5.0 cm in diameter [Figure 2], which had commenced 2 years previously.
Intraoral photograph showing swelling of the anterior alveolar part of the mandible and spacing of incisors are evident
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F3
Intraoral examination also showed an increase in volume in the anterior region of the mandible with a bony consistency, asymptomatic, measuring approximately 4.0 cm in diameter [Figure 3], also with the same time course.
Radiograph of skull demonstrates "ground-glass" appearance of calvarium
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F4
A skull radiograph disclosed a "ground-glass" or "salt and pepper" appearance of the calvarium and loss of cortical lines [Figure 4].
Panoramic radiograph showing expansion of both jaws with nearly homogenous or "ground-glass" trabecular pattern. Note the loss of cortical outline for the incisive nerve canal, poor definition of crestal bone, and inferior cortex of the mandible. The maxillary and mandibular lesions are not clearly distinguishable on this panoramic radiograph
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F5
The panoramic radiograph revealed a thinning of the trabecular bone, resulting in an appearance similar to "ground-glass" or "salt and pepper" [Figure 5].
(a) Intraoral radiograph showing loss of lamina dura of maxillary anterior teeth; (b) Intraoral radiograph showing loss of lamina dura of mandibular anterior teeth
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F6
The intraoral radiograph showed a generalized loss of lamina dura of the most teeth of the maxilla and mandible [Figure 6a and b].
Radiograph showing metastatic calcifications in the joints (red arrow) and subperiosteal resorption of the phalanges (yellow arrow)
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F7
The X-rays of hands showed metastatic calcifications in the joints and subperiosteal resorption of the phalanges [Figure 7].
Histopathologic photomicrograph of the biopsy specimen from the maxillary lesion showing multinucleated osteoclast-like giant cells (H and E, x40)
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F8
The histopathology report showed giant cell lesion (brown tumors of HPT) [Figure 8].
Full-face photograph showing improvement in overall clinical status
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F9
The patient was followed up for 5 years, showing improvement in overall clinical status [Figure 9].
(a) Radiograph of skull showing improvement of the "ground-glass" appearance of calvarium; (b) Panoramic radiograph showing improvement of the pattern of trabecular bone; (c) Intraoral radiograph showing restoration of lamina dura of maxillary anterior teeth; (d) Intraoral radiograph showing restoration of lamina dura of mandibular anterior teeth
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F10
The pattern of trabecular bone of the jaw has also improved [Figure 10a-d], and the lesions of the maxilla and mandible healed [Figure 11a and b].
(a) Intraoral photograph of maxillary lesion showing healing with a small residual deformity; (b) Intraoral photograph of mandibular lesion showing healing
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F11
The pattern of trabecular bone of the jaw has also improved [Figure 10a-d], and the lesions of the maxilla and mandible healed [Figure 11a and b].
(a and b) Radiograph showing resolution of metastatic calcifications and resolution of subperiosteal resorption of the phalanges
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F12
We also observed the disappearance of metastatic calcification and supraperiosteal resorption of the phalanges [Figure 12a and b].