原發性副甲狀腺亢進之下顎骨棕色瘤－病例報告

Brown Tumor over Mandible Caused by Primary Hyperparathyroidism-A Case Report

蘇竣揚(Jyun-Yang Su) ； 蔡國陽(Kuo-Yang Tsai)

《臺灣口腔顎面外科學會雜誌》 25卷1期 (2014/03) Pp. 26-41

摘要

棕色瘤是一種巨細胞病變，發生在副甲狀腺機能亢進的患者。因為嚴重副甲狀腺機能亢進，造成骨頭有溶骨性病變。原發性副甲狀腺機能亢進造成棕色瘤的患者，以切除造成亢進的副甲狀腺為主，棕色瘤大部份會自行痊癒。本報告病例為51歲男性，右手肱骨病理性骨折，藉由全身性影像學檢查，發現身上多處長骨病理性變化，原本懷疑惡性腫瘤造成的全身骨頭轉移，因為左下嘴唇感覺麻木而由骨科轉至本科。理學檢查發現，口內左下顎從門牙到臼齒區腫脹，無壓痛感。經由全身麻醉下切片檢查合併升高的完整性副甲狀腺素，診斷為下顎骨棕色瘤，再轉診至一般外科接受副甲狀腺檢查發現右側副甲狀腺瘤。切除右側副甲狀腺之後，下顎骨病灶逐漸消失，但是出現嚴重低血鈣的後遺症－餓骨症候群，而多次住院接受治療。在此提出單側副甲狀腺切除後，下顎骨棕色瘤病灶在影像學的變化和餓骨症候群的治療方式。

關鍵字

棕色瘤 ； 副甲狀腺機能亢進 ； 副甲狀腺切除手術 ； 餓骨症候群

並列摘要

Hyperthyroidism induced brown tumor is a giant cell osteolytic lesion. Surgical excision of the parathyroid gland is the mainstay of treatment of primary hyperparathyroidism. We reported a of 51-year-old man who has sufferred from pathologic fracture over right humorous and was suspected as malignant neoplasm with bony metastasis noted in whole body bone scan. He was also transferred to our OPD for progressive numbness over left lower lip. Physical examination didn't show tenderness or, swelling over left lower gingival but increased parathyroid hormone was noted. Ginat cell tumor was proved after incisional biopsy. The parathyroid scan demonstrated an adenoma over right parathyroid gland He was then received right parathyroidectomy and the brown tumor of lower jaw resolved spontaneously. However, hungry bone syndrome developed post-operatively and he was admitted many times for treatment.

並列關鍵字

Brown tumor ； Hyperparathyrodism ； Parathyroidectomy ； Hungry bone syndrome