Letter to the Editor Nephron 1993;64:483-484 Gonzalo Orejasa Corsino Rey1 Susana G. Vicentea Laura Fernández Fernando Santosa Serafín Málagaa Section of Pediatric Nephrology and Service of Pathology, Central Hospital of Asturias, University of Oviedo, Spain Maxillary Brown Tumor as Manifestation of Renal Osteodystrophy Dear Sir, Current management of chronic renal failure (CRF) usually prevents the develop ment of serious forms of renal osteodys trophy. However, treatment noncompliance may give rise to severe and almost forgotten manifestations of bone involvement in uremic children with active osseus metabo lism. We report a case of brown tumor in the maxilla of a 3-year-old female with end-stage renal disease (ESRD). A 3-year-old female with ESRD due to bilateral malformative uropathy and under going continuous ambulatory peritoneal dial ysis from the 6th month of life was admitted to our hospital because of swelling of the left side of her face. Chronic medical treatment included subcutaneous erythropoietin and oral administration of calcium carbonate, cal- citriol, sodium bicarbonate, multivitamin supplements, and antihypertensive drugs. However, biochemical control of hyperpara thyroidism had been poor because of the fam ily’s persistent noncompliance with medical therapy and dietetic recommendations. Two months before the admission, she had re ceived a cadaver renal transplant which was extracted I month later because of renal vein thrombosis. Physical examination revealed a firm, fixed, painful, 5x 5 cm mass in the left maxilla. Serum chemistry analysis showed depressed values of 1,25-dihydroxyvitamin Dj (26 nmol/f) and marked elevations of N- terminal parathyroid hormone (339 ng/l) and alkaline phosphatase concentrations (2,144 U/l). X-ray films of the skull revealed radio- lucent lesions affecting the left maxilla and orbit with the salt-and-pepper bone appear ance characteristic of hyperparathyroidism. Fig-1- Axial computerized talmography showing an homogenous, soft-tissue density mass in the left cheek and antrum. Radiological signs of renal osteodystrophy were also present in long bones. Axial compu terized tomography demonstrated a homo geneous, soft-tissue density mass, affecting the left cheek and antrum, and extending towards the nasal cavity and ethmoidal poste rior spaces (fig. I). Fine-needle aspiration cy tology showed aggregates of multinucleated giant cells within a fibrovascular hemorrhagic stroma. Three weeks after admission, the pa tient died as a result of bronchoaspiration and congestive cardiac failure. Although the dos age of calcitriol had been doubled (50 ng/kg/ day), no signs of maxillary mass regression were noticed. The patient’s family did not authorize a postmortem study. Brown tumor is a variant of osteitis fibrosa [I] rarely reported in the hyperparathyroidism Dr. Gonzalo Orejas © 1993 S. Karger AG. Bascl Sección de Ncfrología Pediátrica, Departamento de Pediatría 0028 2766/93/ Hospital Central de Asturias c/Celcstino Villamil s.n. 0643 04X352.75/0 E-33006 Oviedo (Spain)