An Unusual Neck Mass: A Case of a Parathyroid Cyst and Review of the Literature

Abstract

Parathyroid cysts (PC) are an unusual cause of neck swellings. The majority are nonfunctioning and prove to be a diagnostic challenge given their nonspecific physical and radiological characteristics. This is compounded by their rare occurrence, leading them to be overlooked in the differential diagnosis of neck lumps. Imaging techniques fail to determine the origin of these lesions, but a preoperative diagnosis can be achieved by fine-needle aspiration and measurement of cystic fluid C-terminal parathyroid hormone levels. Treatment of nonfunctioning cysts remains controversial and includes needle aspiration, injection of sclerosant, or surgical excision. We present a case of a 44-year-old female presenting with an asymptomatic anterior neck swelling, diagnosed postoperatively as a parathyroid cyst.

An Unusual Cystic Lesion, Parathyroid Cyst

“…[1,3,7] Although most of these theories are associated with embryologic remnants, there are no pediatric cases reported in the literature. [7] The differential diagnosis for PC include a variety of conditions such as thyroid pathologies (i.e.…”

“…[1,3,7,9] It has been reported that ultrasound, computerized tomography or magnetic resonance imaging may be helpful in discriminating solid/cystic cervical masses and showing their anatomical relation, and that thyroid scintigraphy may be helpful in revealing the presence of non-functional cysts, however none of these imaging methods can discriminate the thyroid/parathyroid origin of the lesions. [1,3,[7][8][9] In physical examination, PCs are soft, mobile masses. They have a semitransparent thin wall with smooth and shiny surface, that can easily be dissected from the thyroid tissue and surrounding tissues.…”

“…The embedded parathyroid tissue within the wall is diagnostic. [1,2,6,7] Functional cysts have no lining epithelium, and they are sometimes called false cysts. They may involve hemorrhage and necrosis and a brown or blurred fluid with hemosiderin laden macrophages.…”

“…PCs can be classified as functional and non-functional cysts according to their co-occurrence with hyperparathyroidism. [1,2,6] Although most of these cysts (85-90%) are non-functional, according to the size of the lesion and local compression, symptoms such as pain dyspnea, dysphagia, and hoarseness due to recurrent laryngeal nerve damage are reported. Of the cysts, 10-15% may be functional and they may manifest with acute parathyroid crisis.…”

Non-functioning parathyroid cystic tumour: malignant or not? Report of a case

“…The symptoms of nonfunctioning cysts are limited to those caused by compression of neighbouring structures whereas the problems associated with functioning cysts are related to excessive secretion of PTH and subsequent hyperparathyroidism and hypercalcaemia (45)(46)(47).…”