Peripheral Brown Tumor of the Jaws: Case Report and Literature Review ()
1. Introduction
A brown tumor is a rare, non-neoplastic pseudotumoral lesion that develops secondary to primary, secondary, or tertiary hyperparathyroidism. It arises from excessive bone remodeling caused by increased osteoclastic activity under elevated parathyroid hormone (PTH) levels. The peripheral form occurring in soft tissues adjacent to the alveolar bone is exceptionally rare and typically involves the gingiva. Clinically, it may strongly resemble more common lesions such as peripheral giant cell granuloma (PGCG) [1].
Accurate diagnosis is essential because treatment differs substantially: PGCG typically requires local surgical excision and removal of irritative factors, whereas brown tumors necessitate systemic management of the underlying hyperparathyroidism.
This paper presents a clinical case highlighting the diagnostic difficulty of peripheral brown tumors and provides a literature-based synthesis of their key features and management.
2. Clinical Case
A 38-year-old woman presented with a progressively enlarging vestibular gingival swelling in the right maxillary region over a four-month period.
Intraoral examination revealed a firm, painless, sessile, reddish mass on the alveolar crest. (Figure 1).
Panoramic radiography showed a localized osteolytic zone underlying the lesion (Figure 2).
The lesion was surgically excised and submitted for histopathological analysis (Figure 3).
Microscopically, the specimen showed a lobulated architecture with numerous clustered multinucleated giant cells, fibroblasts, and histiocytes in a richly vascularized stroma (Figure 4).
These features were compatible with a giant cell lesion such as PGCG or brown tumor. Subsequent laboratory tests revealed markedly elevated PTH levels, which supported the diagnosis of a peripheral brown tumor.The patient was referred to endocrinology for further evaluation and management of hyperparathyroidism.
The patient was closely monitored through regular clinical follow-up visits. Healing progressed uneventfully, with satisfactory soft tissue repair observed one week after surgery (Figure 5). At the one-year follow-up, the surgical site demonstrated complete mucosal healing with no clinical evidence of recurrence (Figure 6). In parallel, the patient remained under endocrinological care for the management of the underlying hyperparathyroidism. This favorable outcome highlights the importance of combining local surgical treatment with appropriate systemic management and long-term follow-up to minimize the risk of recurrence.
Figure 1. Intraoral view illustrating the lesion.
Figure 2. Panoramic radiograph revealing marked osteolysis adjacent to the lesion in the right maxillary alveolar ridge.
Figure 3. Macroscopic view of the excised lesion (2 × 3 cm).
Figure 4. H&E-stained histological section showing multinucleated giant cells within a fibroblastic-histiocytic stroma.
Figure 5. Intraoral view showing healing after 7 days.
Figure 6. Follow-up photograph after 1 year.
3. Discussion
Peripheral giant cell lesions of the jaws mainly include PGCG and peripheral brown tumor. Their clinical, radiographic, and histologic overlap makes distinguishing them based on morphology alone difficult. PGCG is a benign reactive lesion generally resulting from chronic irritation or trauma [2]. In contrast, brown tumors represent a skeletal manifestation of hyperparathyroidism and reflect systemic metabolic disturbance rather than a local reactive process [3].
Both lesions contain multinucleated giant cells, hemosiderin deposits, and a fibrovascular background. Thus, systemic assessment is essential: elevated serum PTH strongly suggests a brown tumor [4], whereas normal values favor PGCG.
Peripheral brown tumors most often occur in women over 30 years of age and are commonly located in the edentulous anterior mandible, though maxillary involvement occurs [5]. Clinically, they present as painless, red-to-purple soft tissue masses that may be sessile or pedunculated. Radiographs may reveal underlying bone resorption. Histologically, brown tumors contain abundant multinucleated giant cells, hemosiderin-laden macrophages, and a rich vascular network, giving their characteristic brownish appearance [3].
Management requires both surgical excision and systemic correction of hyperparathyroidism. Parathyroidectomy is indicated in primary hyperparathyroidism, while medical management is used for secondary or tertiary forms, often associated with chronic kidney disease. Recurrence rates remain low (5% - 11%) if both local and systemic factors are appropriately addressed. Long-term follow-up is essential.
4. Literature Review
These studies underline the diagnostic ambiguity between PGCG and peripheral brown tumors. Identifying a systemic brown tumor is crucial, as delayed diagnosis
Table 1. Summary of key literature on peripheral brown tumor and PGCG.
Author(s) |
Year |
Study type |
Key findings |
Relevance to brown tumor |
Chaparro-Avendaño et al. |
2005 |
Case series + literature review (5 PGCG cases) |
PGCG is a common gingival giant cell lesion with clinical and histologic similarity to brown tumors; female predilection. |
Highlights diagnostic confusion and the need to exclude systemic causes (1). |
Cloutier et al. |
2007 |
Retrospective analysis |
PGCGs may occur around implants; associated with local irritation; histology overlaps with other giant cell lesions. |
Supports role of trauma in PGCG and importance of distinguishing it from metabolic lesions (2). |
Batsakis JG |
1986 |
Pathology consultation |
Defines brown tumor as a manifestation of hyperparathyroidism; central and peripheral forms described. |
Foundational reference establishing the concept of brown tumor (3). |
Triantafillidou et al. |
2006 |
Case report + review |
Describes peripheral brown tumor regressing after parathyroidectomy. |
Confirms metabolic etiology and effect of systemic treatment (4). |
Reséndiz-Colosia et al. |
2014 |
Case report |
Peripheral brown tumor mimicking PGCG; diagnosis confirmed by elevated PTH. |
Emphasizes importance of PTH testing in giant cell lesions (5). |
Table 2. Clinical cases of peripheral brown tumors reported in the literature.
Author(s) |
Year |
Patient |
Location |
Diagnosis clue |
Treatment |
Outcome |
Triantafillidou et al. |
2006 |
Female, ~50 y/o |
Mandibular gingiva |
Elevated PTH, lesion mimicking PGCG |
Parathyroidectomy (systemic only) |
Complete regression |
Reséndiz-Colosia et al. |
2014 |
Female, 48 y/o |
Anterior mandible |
Histology + ↑PTH |
Surgical excision + endocrine therapy |
No recurrence |
Batsakis JG |
1986 |
Not specified |
Gingival/peripheral |
Pathology-based analysis |
Not detailed |
Highlighted importance of metabolic screening |
Current case
(Harrizi & Kissi) |
2025 |
Female, 38 y/o |
Right maxillary vestibular gingiva |
Histology + ↑PTH |
Surgical excision + endocrinologist referral |
Ongoing endocrine management |
may postpone necessary endocrinological management. A multidisciplinary approach is strongly advised. Together, these studies underline the diagnostic ambiguity between PGCG and peripheral brown tumors. Identifying a systemic brown tumor is crucial, as delayed diagnosis may postpone necessary endocrinological management. A multidisciplinary approach is strongly advised (Table 1, Table 2).
5. Conclusion
Peripheral brown tumors are rare but clinically important lesions that closely mimic common reactive entities such as PGCG. Because clinical and histological features overlap, a thorough systemic evaluation including serum PTH measurement is essential for correct diagnosis. Treatment requires both surgical excision and management of the underlying hyperparathyroidism. Early identification and coordinated multidisciplinary care are key to preventing recurrence and systemic complications [4].