Diagnostic and therapeutic review of cystic parathyroid lesions

Abstract

BAcKGrOUND: Parathyroid cysts (Pc) are uncommon entities in routine clinical practice. The vast majority are nonfunctioning and are commonly present as asymptomatic nodular cervical lesions. Pc should be considered in the differential diagnosis of an asymptomatic neck mass. Large Pc can manifest with compressive symptoms of the surrounding tissues. OBJEcTIVE: The aim of this study is to describe nine new cases of Pc and review the current literature regarding the clinical presentation, the aetiopathology, the diagnostic procedures, as well as the therapeutic approaches for this relatively rare clinical entity. METHODs-PATIENTs: We present nine new patients (7 females and 2 males) diagnosed with Pc, which in three were ectopic. The diagnosis of Pc was based on the elevated levels of PTH in the cysts fluid. six of the patients had nonfunctioning parathyroid lesions, while the other three had functioning ones. Patients with functioning Pc had elevated serum calcium and PTH levels. Five out of nine of the cases had no symptoms, while two patients had compressive symptoms and the other two had signs and symptoms of hypercalcaemia. Needle aspiration (NA) was performed in five out of six patients with nonfunctioning Pc. surgery was the treatment in all three patients with functioning Pc. rEsULTs: remission after NA was achieved in four out of five patients with non-functioning Pc (follow-up time: 17.7±2.3 months). In two of them, two and three aspirations were needed. One patient with nonfunctioning Pc submitted to surgery with no previous NA. Patients with functioning Pc maintained remission after surgery (mean follow-up time: 22.1±2.9 months). In one of them, a second surgery was performed due to the co-existence of an ectopic parathyroid adenoma. cONcLUsIONs: The diagnosis of a Pc can be established by finding high levels of PTH in the fluid collected by the aspiration of the cyst. PTH and ca levels in the serum can differentiate functioning from nonfunctioning Pc. The treatment of HORMONES 2012, 11(4):410-418 Review

Non-functional parathyroid cyst masquerading as a thyroid cyst: Report of two cases and review of the literature

“…They are typically classified as functional or non-functional, depending on their association with hyperparathyroidism [2]. The majority of cases are non-functional [3]. This report illustrates the diagnostic conundrum associated with a non-functional parathyroid cyst mimicking a cystic thyroid nodule.…”

Parathyroid cysts: the Latin-American experience

“…They are usually found in women, but functional cyst is more frequently found in men (15). The localization is variable between mandible and the mediastinum (3,22). Although parathyroid cysts are usually non-functioning, around 10% may secrete PTH (2) and produce a primary hyperparathyroidism (26)(27)(28).…”

“…Sometimes, parathyroid cysts may resemble giant goiters with extension to the mediastinum compressing the trachea causing obstructive symptoms (2). Treatment options include aspiration, percutaneous sclerosing agents injections or surgical resection (1,3). There are few reports of this disease from Latin America.…”

A rare case of a parathyroid adenoma inside a parathyroid cyst

“…This is a case of parathyroid adenoma within a 4 cm PC. Functional PCs represent 20% of cases, manifest PTH hypersecretion, are revealed in 0.3-3% of the parathyroid glands removed due to primary hyperparathyroidism (3), have no typical location and are found predominantly in men (3,4).…”

“…P arathyroid cysts (PCs) were first described in 1880 and they comprise rare lesions of the neck or mediastinum, with more than eight five percent of them located in the neck, usually involving the lower parathyroid glands, and the rest of them located between the mandible and mediastinum (1)(2)(3)(4). PCs are subdivided into functioning and nonfunctioning depending on their ability to secrete PTH or not.…”