Giant Nonfunctioning Parathyroid Cyst: A Case Report and Review of the Literature

Abstract

Parathyroid cysts are a rare clinical entity that may arise in the neck or mediastinum. They are more common in women and generally present in the fourth and fifth decades of life. Diagnosis of parathyroid cysts is challenging, and despite thorough radiological and cytological investigation, they are often mistaken for thyroid pathology. Definitive diagnosis is often only confirmed following complete surgical resection and histopathological analysis. We present the case of a woman who was referred to our outpatient clinic with a left-sided neck mass and associated compressive symptoms. Initial examination and investigation appeared consistent with a large thyroid nodule. Following surgical resection, the lesion was found to be a parathyroid cyst. Subsequently, we review the available literature on parathyroid cysts with particular emphasis on the diagnostic challenge they pose to clinicians.

Functional cystic parathyroid adenoma with bilateral mandibular brown tumor: a case report

“…Several hypotheses regarding parathyroid cyst's origin are present; one of the theories suggests that they have an embryologic origin from the 3rd and 4th brachial pouches which is supported by the fact that it contains several tissues (adipose, parathyroid, thyroid, etc.) [ 2 , 7 ]. Another theory claims that they arise due to the fusion of former parathyroid microcysts [ 4 , 7 ].…”

“…[ 2 , 7 ]. Another theory claims that they arise due to the fusion of former parathyroid microcysts [ 4 , 7 ]. However, one theory states that functional cystic parathyroid adenoma results from the degeneration, infarction, or hemorrhage into parathyroid glands and adenomas [2] , [3] , [4] .…”

“…However, one theory states that functional cystic parathyroid adenoma results from the degeneration, infarction, or hemorrhage into parathyroid glands and adenomas [2] , [3] , [4] . In addition, the existence of parathyroid tissue within parathyroid cysts walls is pathognomonic [7] .…”

“…Due to the substantial differences in parathyroid cyst's location and functional status, they display considerable variety in clinical presentations [ 5 , 6 ]. In addition, although most parathyroid cysts present asymptomatically and are found during surgery or on imaging indicated for other reasons, some larger and more functional cysts may cause symptoms of obstruction or compression such as swallowing and breathing difficulties, change in voice, symptoms of hypercalcemia such as kidney stones, bone pains, and constipation, or even parathyroid crisis [ 2 , [5] , [6] , [7] ].…”

“…Several imaging modalities such as ultrasound, computed tomography, or Tc-99m Sestamibi scintigraphy can be used to detect the presence of functional cystic parathyroid adenomas and parathyroid cysts [4] , [5] , [6] . However, ultrasound is considered the best initial modality as its noninvasive, can help in differentiating the cystic nature of the mass, and can be done along with fine needle aspiration, which is of great diagnostic and therapeutic value in such cases [ 6 , 7 ]. It's worthy to mention that Tc99-m Sestamibi scintigraphy may reveal a false negative result due to a lack of uptake of the tracer [ 2 , 5 ].…”