Images in Clinical Medicine
Renal Osteodystrophy of the Palate
N Engl J Med 2008; 359:74July 3, 2008
- Article
A 20-year-old man who had had idiopathic end-stage renal failure since he was 12 years of age and who was undergoing dialysis once weekly (with stable serum electrolyte, blood urea nitrogen, and serum creatinine levels) presented with a large, nontender mass on his hard palate that had grown during a 10-month period (Panel A). Computed tomography revealed a round, expansile lesion arising from the hard palate with evidence of ossification (Panels B and C). The serum calcium level was 9.5 mg per deciliter (2.4 mmol per liter), and the serum phosphorus level was 7.0 mg per deciliter (2.3 mmol per liter). He was not receiving supplemental calcium or vitamin D or phosphate binders. The serum parathyroid hormone level, on two separate occasions, was 180 and 260 ng per deciliter (normal, <27 ng per deciliter). Fine-needle aspiration of the mass showed many osteoclasts. The tumor was excised and was found to be composed of bony trabeculae in a fibrotic stroma with many osteoclasts, a finding consistent with osteitis fibrosa (renal osteodystrophy). The patient's recovery was uneventful. He was discharged 2 days after surgery and was well 6 months later. Renal osteodystrophy is caused by secondary hyperparathyroidism and deficiency of 1α,25-dihydroxycholecalciferol.
Yahya Daneshbod, M.D.
Dr. Daneshbod Pathology Laboratory, Shiraz 71347, Iran
y@daneshbod.com - Citing Articles (2)
Citing Articles
1
Mark A. Lerman, Catherine Do, Lakshman Gunaratnam, Cyelee Kulkarni, Kevin Tucker, Sook-Bin Woo. (2011) Localized mandibular enlargement in end-stage renal disease: two case reports and a review of the literature. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
CrossRef2
R.-M. Javier, B. Moulin. (2010) Complicaciones osteoarticulares en los pacientes hemodializados (con excepci
n de la osteodistrofia renal). EMC - Aparato Locomotor 43:1, 1-12
CrossRef
