Giant-cell tumor and brown tumor in patients with renal failure and secondary hyperparathyroidism

Introduction
Central giant-cell granuloma and brown tumor are intraosseous lesions, and their etiology is not fully known. They are commonly observed in maxillofacial region in mandibular and maxillary bone. A central giant-cell lesion is not considered to be a neoplasm. Lesions diagnosed in patients with hyperparathyroidism are called “brown tumors”. Their development is associated with high serum levels of parathyroid hormone in the course of primary and secondary hyperparathyroidism that are complication of renal failure. Clinically central giant-cell granuloma and brown tumor manifest as painless bone protrusion covered with normal mucosa.

Case presentation
The objective of the study was to present diagnostic process and treatment of three pedia­tric patients with end-stage renal failure who developed brown tumors (two patients with secondary hyperparathyroidism) and central giant-cell granuloma (one patient without hyperparathyroidism) in bones of the facial skeleton. Surgical treatment was implemented in all patients.

Conclusions
When central giant-cell granulomas and brown tumors of the maxilla are suspected in patients at the developmental age, it is necessary to perform a computed tomography examination because lesions may not be always visible in radiological images. Surgical resection of a lesion, but without adjacent teeth combined with a treatment of secondary hyperparathyroidism, is an effective method of management.