Successful Treatment Of Parathyroid Cyst Using Ethanol Sclerotherapy

Abstract

Simple parathyroid cysts are rare; only about 200 cases have been reported in the literature. The diagnosis was facilitated recently by parathyroid hormone assay of the cyst fluid. Standard treatment consists of percutaneous aspiration of the cyst and surgical excision for recurrent lesions. Sclerotherapy of recurrent lesions was described in two cases and results were promising. The authors report a new case of recurrent nonfunctioning parathyroid cyst in a 34-year-old female, with complete resolution after ethanol sclerosis and no recurrence for 15 months of follow-up. Ethanol sclerotherapy is recommended as a simple and safe treatment for recurrent parathyroid cysts.

Diagnosis and Therapeutic Management of Parathyroid Cysts

“…Parathyroid cysts can be functional and secretary, causing hyperparathyroidism in 10% -15% of cases [3,5,20,23], 20% in our trial. Only 1% -5% of cases of hyperparathyroidism are caused by parathyroid cysts (in our experience there were five FPCs every 538 cervicotomies for parathyroid pathology, 0.9%) FPCs, most frequently encountered in male patients, are typically degenerative or are bleeds from an adenoma [14,16,21].…”

“…Rarely there are clinical signs corresponding to a complication: cervical pain [1,3,11,19] and/or thoracic pain [18] or compression symptoms [3,8,11,16,[18][19][20], dyspahgia (one of our observations), dysphonia [5,20] dyspnoea, dry cough or stridor [15,21] deviation and vascular compression [11,18,22]. Systemically the patient will be normal unless the cyst causes significant hyperparathyroidism which itself can be symptomless.…”

“…In these cases surgery [3,8,20,22,28] repeated fine needle aspiration until the cyst disappears [1,2,23] or intracystic injections to cause sclerosis (tetracycline [27] or ethanol [3,4]) can then be considered. Intracystic injections are accompanied by pain, fever and transient breathlessnesss in 5% of cases [4,6,20].…”

“…Intracystic injections are accompanied by pain, fever and transient breathlessnesss in 5% of cases [4,6,20]. This technique presents risks of pericystic fibrosis (especially with ethanol injections) which can lead to recurrence of the cyst [3]. It is for this reason that Verges et al advise that whilst carrying out the technique one should speak to the patient and, at the slightest suggestion of dysphonia, should stop the procedure (4 transient dysphonias out of 13 patients in their trial) [29].…”

“…Their treatment is most often surgical (resection by the cervical or thoracic route). However in certain cases, newly developed ultrasound guided fine needle aspiration and sclerosing injections can be used in their management [3,4]. We report a unicentric sample of twenty-five patients managed in the department of General & Endocrine Surgery which allowed us to compare our results and recommendations with those published in the literature.…”