- Advanced Disease:
- osteoclastic resorption may become so severe that no bone is seen;
- there is granulation tissue w/ fibroblasts, giant cells, inflammatory cells, and macrophages, containing hemosiderin in many cases;
- this is characteristic of a brown tumor of hyperparathyroidism;
- due to increase in number of bone remodeling centers, there is increase in number of bites taken out of the bone at any one time, w/ a
resultant increase in the amount of bone which is missing at any one time;
- reduction in number of trabeculae;
- increase in multinucleated giated cells in Howship's lacunae;
- replacement of the normal cellular and marrow elements by fibrous tissue;
- brown tumors:
- occurs in severe cases;
- referred to as "giant cell tumor of diaphysis"
- microscopical exam revealed that it was composed of numerous osteoclasts with stromal hemorrhage