The bony complications in
secondary hyperparathyroidism in
chronic renal failure are varied. The
ossifying fibroma is a rare manifestation. We report a case of a 40 years old woman with indeterminate nephropathy undergoing
hemodialysis since 1982. Since may 1995, the patient had a diffuse and intensive bone
pain of the two inferior members inducing functional importance with apparition of endobuccal tumefaction in the hard palate with an important increase of the volume of the maxillo-mandibular complex six months later associated to disturbances of the deglutition and phonation. In december 1995, the serum
parathyroid hormone level is measured at 1527.6 pg/ml and the serum
alkaline phosphatase level at 1620 UI/l. The bony lesions are disseminated to all the skeleton in the form of a demineralization with an ossifying expansive process affecting the maxillo-mandibular complex. Calcemia was at 2.3 mmol/l and phosphoremia at 2.1 mmol/l. The surgical biopsy of this pseudotumor showed an aspect of
ossifying fibroma. The cervical echography showed a left inferior parathyroid nodular. In june 1996, a subtotal
parathyroidectomy was done. The 9th day after surgery, the serum
parathyroid hormone level was at 103 pg/ml with normal calcemia and phosphoremia. Five years later, the volume of the
tumor reduced moderately. This observation induces 3 commentaries: the bony manifestations associated to
secondary hyperparathyroidism have sometimes a tumoral aspect, the
ossifying fibroma may be for known as well as the brown
tumor and the treatment of these
tumors in complex justifying furthermore a rigorous prevention of the
hyperparathyroidism in hemodialyzed patients.