(0613) Brown Tumor in Nose and Paranasal Sinuses: Report of Two Cases

Introduction: The brown tumor is one of the rare local bone manifestations of uncontrolled primary or secondary hyperparathyroidism. The prevalence is 0.1% in general, and of them, 4.5% are found in the facial region. They comprise non-neoplastic tissue, with intense bone resorption, as well as accumulation of hemosiderin pigment. They are difficult to control and their treatment must be aimed at symptomatic control.

Methods: The case of 2 young patients is presented, a 31-year-old female and a 23-year-old male with chronic kidney disease undergoing renal replacement therapy, who presented with nasal obstruction and increased hemifacial volume in the malar area. Both have complaints about aesthetic deformity and epistaxis.

Results: A tomography was requested where the main finding was tumors with well-defined edges in the nose and paranasal sinuses with expansive characteristics that have a hyperdense halo corresponding to bone, as well as calcifications inside. The parathyroid hormone values were over 2,000 pg/mL. A sestamibi gammagram showed functional parathyroid adenomas. In the management of both patients, parathyroidectomy with subsequent surveillance was decided with favorable outcome.

Conclusions: There are few reports of osteoclastomas in the nose and paranasal sinuses. The etiology in most cases is a solitary adenoma or multiple adenomas representing 30%, the remaining cases are manifested by hyperplasia in 19% and carcinomas in 1%. They are mostly asymptomatic or may produce symptoms due to compression of the adjacent structures. Tomography plays an important role, characteristically demonstrating well-defined irregular osteolytic lesions with contrast enhancement. They are difficult to control and the mainstay of treatment is the decrease in parathyroid hormone levels. Surgical resection will depend on its location, extension and symptoms due to its high morbidity and mortality.