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Laryngorhinootologie 2020; 99(03): 168-172
DOI: 10.1055/a-1039-1630
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© Georg Thieme Verlag KG Stuttgart · New York

Epistaxis as an initial symptom of brown tumor in hard palate: a rare case report and review

Nasenbluten als erstes Symptom eines braunen Tumors: Ein seltener Fall, Bericht und Überprüfung
Xiaoyan Chen
1  Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
,
Xudong Yan
1  Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
,
Hai Zhao
2  Otolaryngology Head and Neck Surgery, Qingdao Municipal Hospital Group, Qingdao, China
,
Xue Yan Zhang
1  Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
,
Pei Liu
3  Department of Anesthesiology, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
,
Yan Jiang
1  Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
,
Jianbao Ju
1  Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
› Author Affiliations
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Publication History

Publication Date:
28 November 2019 (online)

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Introduction

Brown tumors are uncommon and very aggressive benign intraosseous neoplasm caused by abnormally high parathyroid hormone levels (hyperparathyroidism; HPT). The ratio of female cases to male cases is approximately 2:1. The classical “brown tumor” is commonly observed in long bones, pelvis, and ribs [1] [2]. Only 4.5 % of brown tumors involve the facial bones [3]. The mandible is the predominantly affected site in the maxillofacial area [4]. Moreover, the palate as a site of brown tumors has only been reported in a limited number of papers, as determined through our PubMed search [5] [6] [7] [8] [9] [10]. In most cases, brown tumors represent late manifestations of primary hyperparathyroidism (PHPT) [11]. Pathological results include adenoma in approximately 80 % of cases, followed by glandular hyperplasia (15 %) and parathyroid carcinoma. Hypercalcemia and hypophosphatemia are commonly noted in PHPT [12]. Secondary hyperparathyroidism (SHPT), which is induced by defective phosphate excretion and failure of vitamin D activation, also plays a role in brown tumor formation. Elevated phosphate levels, as well as decreased calcium and serum vitamin D levels, lead to the persistent stimulation of the parathyroid glands, which increases PTH release [12] [13] [14]. Hyperparathyroidism may present as anorexia, vomiting, constipation, fatigue, weight loss, muscle weakness, psychiatric symptoms, anemia, polydipsia, urologic changes, and recurrent symptoms of kidney stones during the early stage [15] [16]. However, many of these early symptoms are often ignored [17]. Nevertheless, clinical, biochemical, and radiologic findings can easily guide the diagnosis if physicians carefully consider all the findings and their association with the subject's medical history, instead of focusing only on the bone lesion [18]. In the present case, the patient was admitted to our department for repeated epistaxis with nasal congestion on one side, which are typical manifestations of a brown tumor involving the hard palate and maxillary sinus [15] [19].