Table 1.

Clinical and diagnostic characteristics of three cases with Brown tumors secondary to hyperparathyroidism.

Feature	Case 1	Case 2	Case 3
Age / gender	45-year-old female	22-year-old female	60-year-old female
Medical history	No systemic illness	Chronic renal failure on hemodialysis	No systemic illness
Lesion location	Left posterior mandible	Left posterior maxilla and right anterior mandible	Bilateral maxilla (more on left)
Clinical presentation	Firm, painless swelling; buccal and lingual expansion	Bilateral firm swellings; buccal expansion	Painless swelling with vestibular and palatal expansion
Radiological features	Mixed-density expansile lesion; cortical expansion and perforation	Multifocal osteolytic lesions; maxillary perforation; mandibular expansion	Two maxillary lesions; larger ill-defined with perforation; smaller well-defined
Histopathology	Giant cell lesion (CGCG)	Giant cell lesion (CGCG)	Giant cells with hemosiderin (brown tumor features)
Biochemical profile	↑ PTH (914.5 pg/mL), ↑ calcium (12.8 mg/dL), ↓ phosphate	↑ PTH (1070 pg/mL); normocalcemia and normophosphatemia	↑↑ PTH (2062 pg/mL), ↑ calcium (13.3 mg/dL), ↓ phosphate, ↑ ALP (398 U/L)
Parathyroid imaging	Hypoechoic left parathyroid mass	Bilateral retrothyroid nodules	Hypervascularized left parathyroid nodule (54 × 13 mm)
Final diagnosis	Jaw brown tumor due to primary hyperparathyroidism	Jaw brown tumors due to secondary hyperparathyroidism	Jaw brown tumors due to primary hyperparathyroidism
Management and outcome	Focused parathyroidectomy (no jaw surgery); normalisation of serum calcium and PTH; radiological regression at 6 months and marked regression with restored trabecular pattern at 12 months; no complications (Clavien-Dindo 0).	No jaw surgery; medical metabolic management (dietary phosphate restriction, phosphate binders, calcitriol, cinacalcet, dialysis optimisation) coordinated by nephrology and endocrinology; progressive lesion reduction at 6 months and further regression at 12 months; no complications (Clavien-Dindo 0).	Correction of hypercalcemia (hydration + loop diuretics) then focused parathyroidectomy with intraoperative PTH monitoring (no jaw surgery); normalisation of calcium, PTH and ALP; regression of both maxillary lesions at 6 and 12 months; no complications (Clavien-Dindo 0).