Parathyroid cyst: a rare cause of an anterior neck mass

Parathyroid cysts: A review of 359 patients reported in the international literature

BACKGROUND

Parathyroid cysts are lesions that represent 1-5% of neck masses. They are subdivided into two categories: functioning and non-functioning.The aim of the present review is to give a detailed account of all reported cases of parathyroid cysts in the literature and to analyze statistically the available data.

METHODS

A bibliographic research was performed from 1905 until 2016. A database with the patients' characteristics was made and analyzed statistically.

RESULTS

A total of 218 articles were found, reporting 359 cases of cysts. Mean age of patients was 49.24 y/o and the male/female ratio was 1:1.85. The most common locations were left thyroid lobe (113/358 patients, 31.6%), and superior mediastinum (69/358 patients, 19.3%), while the most common symptoms were neck mass (148/355 patients, 41.7%), compressive symptoms (73/355 patients, 206%) and hyperparathyroidism (62/355 patients, 17.5%). Non-functioning cysts were more frequent (220/357 patients, 61.6%). Regarding dimensions, mean diameter was 4.88 cm. Ultrasound and FNA are used for their diagnosis, while cystic fluid analysis may help the differential diagnosis. Recurrences were mentioned in 27/97 patients (27.8%) with available data. No deaths due to parathyroid cysts were mentioned in the literature.

CONCLUSION

Parathyroid cysts should be taken into consideration in case of parathyroid dysfunction or asymptomatic neck mass. The surgeon's careful manipulations on the cyst are crucial for a definitive treatment.

Functional parathyroid cyst in a patient with systemic lupus erythematosus: a case report

Functional parathyroid cysts are a rare cause of primary hyperparathyroidism and are often mistaken for thyroid cysts. Systemic lupus erythematosus (SLE) is also a very rare cause of hypercalcemia. We report the case of a 62-year-old woman, who was diagnosed with SLE 30 years ago, presenting with clinical and biochemical features of primary hyperparathyroidism. Laboratory investigation revealed increased serum calcium and parathyroid hormone (PTH) levels; neck ultrasonography (USG) revealed 40×34×26 mm cystic mass in the left lobe of thyroid gland. PTH level in the cysts was >2500 pg/ml, determined by USG-guided fine-needle aspiration (FNA). In this case, no evidence for potential pathogenic association between parathyroid cyst and SLE was uncovered. However, the recognition of this association is very important because the therapeutical strategy is completely different. Operative management is usually straightforward and alleviates symptoms and any biochemical abnormalities caused by the cyst.

Nonfunctional parathyroid cyst: case report

CONTEXT

Parathyroid cysts are rare clinical and pathological entities, with less than 300 cases reported. The inferior parathyroid glands are most commonly involved, with left-side predominance. Parathyroid cysts may be functional or nonfunctional, depending on their association with hypercalcemia.

CASE REPORT

A 25-year-old man presented a palpable asymptomatic left-side neck mass. Ultrasound revealed a cystic structure contiguous with the left thyroid lobe. Serum ionic calcium was normal. The patient underwent left thyroid lobectomy plus isthmectomy with excision of the cyst. The histological findings revealed a parathyroid cyst. Parathyroid cysts typically present as asymptomatic neck masses, and surgical excision appears to be the treatment of choice.

A single-institution 25-year review of true parathyroid cysts

BACKGROUND

Parathyroid cysts (PCs) are rare, and their origin is a subject of debate. They have been described as either functional, causing hyperparathyroidism, or non-functional in eucalcaemic patients.

PATIENTS AND METHODS

We have performed a 25-year departmental review of PCs. Features studied included the clinical presentation and intra-operative findings, and a histological review was performed. Cases of cystic degeneration of parathyroid adenomas and pseudocystic change were excluded.

RESULTS

Over 25 years, 22,009 thyroidectomies and 2,505 parathyroidectomies were performed in our department. Amongst these, 38 non-functional PCs were documented in 37 patients. The mode of presentation included incidental findings on routine chest x-ray, compressive symptoms or an asymptomatic palpable neck mass. Aspiration was the initial treatment in 14 patients and was curative in 10 of these. Four out of 14 patients underwent surgical procedures for recurrence of the cyst that occurred 6 to 48 months after aspiration. In 27 patients, surgery was performed and all identified PCs were localized in the inferior parathyroid glands. Histologically, the cyst wall consisted in associations of lymphoid, muscular, thymic, salivary, adipose and mesenchymal tissues.

CONCLUSIONS

PCs are rare but should be included within the differential diagnosis of a neck lump. True PCs are non-functional. Pathological and immunohistochemical findings are suggestive of a branchial origin. Fine-needle aspiration may be curative and is diagnostic due to the characteristic appearance of the fluid and high PTH levels on assay.

Intraparathyroid cyst: a tumour of branchial origin and a possible pitfall for targeted parathyroid surgery

BACKGROUND

Parathyroid cysts account for 0.5% of parathyroid pathologies. They usually contain sky-high levels of parathyroid hormone (PTH) but are not necessarily associated with primary hyperparathyroidism (PHPT). Their origin is subject to debate. We provide evidence for a branchial origin and illustrate some potential problems they pose for targeted parathyroid surgery.

METHODS

The present study is a single institution retrospective study of 1702 parathyroid and 10 021 thyroid operations performed over a period of 12 years (1990-2001). Twenty-three cases of parathyroid cyst were found: three palpable neck masses, four cases associated with PHPT and 16 incidental findings at the time of thyroid surgery. Intracystic PTH measurements and immunostaining of the lining wall of the cyst were obtained in 16 out of 23 and 18 out of 23 cases, respectively.

RESULTS

Intracystic PTH levels were elevated in 15 out of 16 cases (average 3877, range 36 000-23 pg\mL). The wall of the cyst stained positively for epithelial cuboidal cell markers (CK +ve) and negatively for PTH (PTH -ve) in 18 out of 18 cases. In only one quarter of the cases associated with PHPT was the cyst the hypersecreting gland, nevertheless it contained less than the average PTH level (1440 vs 3877) and did not take up sestamibi. Results were conflicting in the other three cases. Histological studies on the present series suggest a branchial pouch origin.

CONCLUSION

Despite containing high levels of PTH, parathyroid cysts are of branchial origin and when associated with PHPT are rarely responsible for the disease. Targeted parathyroid surgery should not rely only on ultrasound and intraparathyroid PTH measurements.

[Parathyroid cyst in the differential diagnosis of neck masses. A case report]

Parathyroid cysts are rarely seen in clinical practice. They should always be included in the differential diagnosis of neck masses. Conclusive diagnosis should be established by fine-needle aspiration (FNA), a procedure that is useful for both diagnostic and therapeutic purposes.We report the case of girl who aroused clinical suspicion of thyroid node. However, the diagnosis of parathyroid cyst was subsequently confirmed by FNA.

[Parathyroid cyst. Report of one case]

Parathyroid cysts are rare in clinical practical. We report of 33 years old woman, with a cystic lesion in the right lobe of thyroid. The content of the cyst obtained through needle aspiration, showed a high PTH concentration (parathyroidhormone). The patient underwent surgery and the cyst was removed. The anatomopathological diagnosis was a parathyroid cyst.

[Parathyroid cyst. Report of ten cases]

AIM OF THE STUDY

To evaluate the characteristics of the parathyroid cysts (PC).

PATIENTS AND METHOD

Ten patients with PC were included in this retrospective study. The PC were discovered as follows: cervical mass (n = 3), hyperparathyroidism (n = 3), incidentally during thyroid surgery (n = 3) and screening for obesity (n = 1). Intracystic parathormone determination was performed after fine needle aspiration in 2 cases.

RESULTS

Mean cyst measurements were 27 mm (ext: 5-70 mm) to 22 mm (5-45 mm). Nine cysts were cervical (resection by cervicotomy), and one was mediastinal (resection by sternotomy). In addition to the resection of the PC, 3 adenomas, 1 hyperplasia of the parathyroid glands and 3 benign thyroid diseases were recognized and treated during the cervicotomies.

CONCLUSION

The diagnosis of PC is not common and must be based primarily on the study of the cyst liquid obtained by percutaneous puncture (intracystic parathormone measurement).