Bilateral Brown Tumors of Maxilla with Primary Hyperparathyroidism

On examination, a 7-8 cm sized non-tender, immobile, smooth surfaced, hard mass was palpated beneath the right nasolabial fold. Another mass around 1-1.5 cm in size was palpated beneath the left nasolabial fold (Figure 1). Anterior rhinoscopy revealed a round, mucosal-covered mass extending along the floor and lateral wall of nose into the right nasal vestibule. No proptosis or extra-ocular muscle involvement was noted. Examination of the oral cavity was unremarkable except for a bulge in the upper gingivolabial sulcus on right side. No Cervical adenopathy was apparent. A computed tomography scan of the paranasal sinuses demonstrated an expansile multiloculated osteolytic lesion with soft tissue density within, involving both the maxillae (Figure 2). With the diagnosis of a metabolic disease, laboratory investigations revealed a high serum calcium (12.9 mg /dl ) and a low phosphate level (2.1mg/dl), a raised 24 hour urine calcium of 411 mg/day and a markedly raised urine calcium/creatinine ratio of 0.65 (normal <0.2)and a normal 25(OH))VIT D levels.