Ultrasound-guided anhydrous ethanol and microwave ablation for functional parathyroid cyst: a case report / 南方医科大学学报

We report a case of functional parathyroid cyst treated by ultrasound-guided anhydrous ethanol sclerotherapy and microwave ablation. The 63-year-old female patient was diagnosed to have functional parathyroid cyst with hypercalcemia, high PTH and cystic space-occupying lesions in the neck by ultrasound, radionuclide scanning and PTH measurement of the cystic fluid. The patient refused to receive cyst resection, and anhydrous ethanol sclerotherapy with microwave ablation was performed under ultrasound guidance. The procedure was completed smoothly without any complications either during or after the operation. Follow-up examination of the patient at 18 months after the operation showed a significant reduction of the mass and normal blood calcium and iPTH levels, demonstrating a clinical cure of the patient. Ablative treatment of functional parathyroid cyst has not been documented so far. This approach provides a minimally invasive treatment modality for such cases where surgical resection is not an option, but its efficacy and safety need to be evaluated in more cases with longer follow-up time.

Functional parathyroid cystic adenoma: A rare cause of hypercalcemic crisis with primary hyperparathyroidism.

We discuss a case of primary hyperparathyroidism caused by a giant cystic parathyroid adenoma presenting with neck swelling and hypercalcemic crisis. Fine‑needle aspiration cytology of presumed thyroid swelling from one of the two sites aspirated yielded clear fluid but was not attributed to parathyroid pathology. Elevated serum calcium and intact parathormone (iPTH) levels suggested preoperative parathyroid pathology. Ultrasound neck and sestamibi scan for parathyroid localization were not conclusive. Due to resistant hypercalcemia, the patient underwent emergency bilateral neck exploration and excision of the identified left superior parathyroid cyst along with total thyroidectomy. Monitoring of intra‑operative iPTH helped complete removal of hyperfunctioning parathyroid tissue. Histopathological examination confirmed the parathyroid cyst. Cystic parathyroid adenoma should be considered in the differential diagnosis of cystic neck lesions.

The diagnosis and treatment of non-functional parathyroid cysts / 中华内分泌外科杂志

Objective To investigate the strategy of diagnosis and treatment for non-functional parathyroid cysts.Methods The clinical data of non-functional parathyroid cysts patients undergoing resection between Jan.1991 and Jan.2013 in Peking Union Medical College Hospital were retrospectively analyzed.Results Non-functional parathyroid cysts were confirmed by intra-operation exploration and post-operation pathology in 22 patients.Ultrasound scan revealed cervical cystic lesions in all patients before operations,and concomitant lesions in thyroid were found in 10 patients.The serum calcium and phosphate level were in normal range in all patients.Local excisions were performed in 11 cases for isolated cyst.Subtotal thyroidectomy were performed in 10 cases for concomitant nodular goiter or close anatomy association cyst and thyroid.Radical resection of thyroid and cervical lymph node dissection were performed in one patient for concomitant thyroid carcinoma.No operation related complications was recorded in these series.No relapse presented in these patients after more than 7 months of follow-up.Conclusion Non-functional parathyroid cysts should be considered in the differential diagnosis of cervical mass even though it rarely occurs.Surgical resection was one promising treatment for non-functional parathyroid cysts.

A Case of Primary Hyperparathyroidism Caused by Cystic Parathyroid Adenoma, Diagnosed during Intra-Operative PTH Monitoring / 대한내분비학회지

Primary hyperparathyroidism is the most frequent cause of hypercalcemia, and its prevalence is increasing due to the routine examination of serum calcium levels. Primary hyperparathyroidims is most commonly caused by an adenoma or hyperplasia of the parathyroid gland. A cystic parathyroid adenoma is an extremely rare cause of primary hyperparathyroidism. In our case, a-79-year old female presented with lower back pain and constipation. Her serum calcium, phosphate and immunoreactive parathyroid homone levels were 15.6, 1.8mg/dL and 371.8pg/mL, respectively. Neck CT revealed a cystic mass and a contour bulging heterogeneous mass in the left inferior right thyroid gland, respectively. These mass lesions were removed, and the intra-operative parathyroid hormone levels monitored, to confirm the complete resection. After removing the left cystic mass to the inferior thyroid, the serum calcium and immunoreactive parathyroid hormone levels quickly returned to normal. We report a case of primary hyperparathyroidism, caused by a cystic parathyroid adenoma, with a brief review of the literature

A Case of Primary Hyperparathyroidism Caused by Cystic Parathyroid Adenoma, Diagnosed during Intra-Operative PTH Monitoring / 대한내분비학회지

Primary hyperparathyroidism is the most frequent cause of hypercalcemia, and its prevalence is increasing due to the routine examination of serum calcium levels. Primary hyperparathyroidims is most commonly caused by an adenoma or hyperplasia of the parathyroid gland. A cystic parathyroid adenoma is an extremely rare cause of primary hyperparathyroidism. In our case, a-79-year old female presented with lower back pain and constipation. Her serum calcium, phosphate and immunoreactive parathyroid homone levels were 15.6, 1.8mg/dL and 371.8pg/mL, respectively. Neck CT revealed a cystic mass and a contour bulging heterogeneous mass in the left inferior right thyroid gland, respectively. These mass lesions were removed, and the intra-operative parathyroid hormone levels monitored, to confirm the complete resection. After removing the left cystic mass to the inferior thyroid, the serum calcium and immunoreactive parathyroid hormone levels quickly returned to normal. We report a case of primary hyperparathyroidism, caused by a cystic parathyroid adenoma, with a brief review of the literature

Functional Parathyroid Cyst: A case report / 대한내분비외과학회지

Parathyroid cysts are uncommon lesions of the neck and superior mediastinum, rarely large enough to be of clinical significance. They frequently present as a clinical diagnostic problem. They may mimic solitary thyroid nodule. They can be classified as either functioning or non-functioning depending on whether or not they are associated with hypercalcemia. Non-functioning or “true” cysts are those associated with normocalcemia (85%), whereas functioning or “pseudocysts” are those associated with hypercalcemia (15%). The presence of a high content of intact parathyroid hormone (intact PTH) in the cystic fluid on fine-needle aspiration (FNA), in conjunction with an elevated serum calcium and intact PTH is diagnostic of a functional parathyroid cyst. A functional parathyroid cyst usually requires surgical removal. We report herein one case of functional parathyroid cyst.

Parathyroid Cyst: Description of Two Cases and Review of the Literature / 대한내분비외과학회지

Parathyroid cysts are uncommon causes of neck or mediastinal masses. They have been mistaken for cystic thyroid nodules, brachial cleft cysts, or thyroglossal duct cysts. Two types of parathyroid cysts have been recognized; the non- functioning forms, which are more frequent and the functioning paratyroid cysts, which are rarer and cause hyperparathyroidism. Parathyroid cysts are usually located in the inferior parathyroid gland, which are most commonly involved with a left-sides predominance. Although their location in mediastinum has also been described. Parathyroid cysts may present as a diagnostic problem. It is sometimes difficult that parathyroid lesions are distinguished from thyroid ones with current imaging techniques. Diagnosis is based on the histopathological appearance of the cyst and PTH level in the cystic fluid. Percutaneous needle aspiration of parathyroid cysts reveals crystal clear fluid. Elevated PTH levels in the cystic fluid confirms the diagnosis. The presence of parathyroid tissue within the cyst wall is diagnostic. Nonfunctioning cyst may be treated with aspiration alone, surgical excision is indicated for functioning cyst. We present the case of two patients with a parathyroid cyst.

Diagnostic Approach and Treatment for Parathyroid Cyst / 대한내분비외과학회지

PURPOSE: Parathyroid cysts are rare clinical entities of the neck and superior mediastinum. These cysts often present a difficult diagnostic challenge. They often present as a solitary thyroid nodule and may be difficult to differentiate clinically. The objectives of this study were to review our 27 cases of parathyroid cyst and to suggest the method of diagnostic approach and treatment for parathyroid cyst. METHODS: A retrospective study was performed for a 24-year period (1981~2004), on 27 patients operated of parathyroid cyst. RESULTS: Most of these patients (22/27) complained asymptomatic anterior neck mass at presentation. Preoperative radiologic examinations included ultrasonography (70.4%), computed tomography (25.9%), and (99m)Tc thyroid scan (22.2%). Hypercalcemia was detected in 3 cases with high serum calcium (11.3 mg/dl) and intact PTH (158.1 pg/mL). Fine Needle Aspiration (FNA) was performed in nineteen cases. It revealed crystal clear aspirate in non-functioning cysts and hemorrhagic in functioning cysts. In the analysis of the aspirate, mean N-terminal PTH (n=10) and intact PTH (n=9) were 22.5 pg/mL (9.3~45.0) and 686.5 pg/mL (138.0~1500.0), respectively. Mean size of the cysts was 4.0 cm (1.0~9.2) and the left inferior parathyroid glands were most commonly involved (63.0%). All parathyroid cysts were surgically removed. CONCLUSION: Parathyroid cysts need to be differentiated from other cystic lesions in the neck and superior mediastinum. Aspiration of crystal clear fluid is highly suggestive of a parathyroid cyst. The aspirate should be analyzed for PTH levels as these are always elevated in parathyroid cysts, regardless of the function. Nonfunctioning cysts may be treated with aspiration alone or sclerosing agents. Surgical excision is indicated for functioning cysts and recurrent case of nonfunctioning cysts.

Functional Parathyroid Cyst

Parathyroid cysts are uncommon lesions of the neck and superior mediastinum, rarely large enough to be of clinical significance. They frequently present as a clinical diagnostic problem. They may mimic solitary thyroid nodule. They can be classified as either functioning or non-functioning depending on whether or not they are associated with hypercalcemia. Non-functioning or "true" cysts are those associated with normocalcemia (85%), whereas functioning or "pseudocysts" are those associated with hypercalcemia (15%). The presence of a high content of intact parathyroid hormone (iPTH) in the cystic fluid on fine-needle aspiration (FNA), in conjunction with elevated serum levels of calcium and iPTH is diagnostic of a functional parathyroid cyst, which usually requires surgical removal. We report herein two cases of such a functional parathyroid cyst and present a review of the literature.

Parathyroid Cyst

Parathyroid cysts are an uncommon cause of neck masses, which are rarely suspected before surgery. Although several theories of their origin have been proposed, none has been proven satisfactorily to the exclusion of the others. We experienced a 33-year-old euthyroid woman presenting with a mass on the jugular notch. She complained of throat discomfort. An ultrasound of the mass in the neek suggested a thyroglossal duct cyst. Treatment consisted of a neck exploration and the removal of a 4x3x3 cm cystic mass. The cystic mass contained a clear fluid with a high level of parathyroid hormones in excess of 11.4 ng/ml. The pathological diagnosis revealed a benign parathyroid cyst. This report reviews current knowledge of parathyroid cysts as well as the relevant literature.

Minimally invasive video-assisted parathyroidectomy / 中国微创外科杂志

Objective To investigate the feasibility and effects of minimally invasive video-assisted parathyroidectomy(MIVAP)for parathyroid adenoma or cyst.Methods A 2 cm skin transverse incision was made above the suprasternal notch.Without gas insufflation,a cavity was built with retractors.Under endoscopic assistance,parathyroidectomy was performed by using a harmonic scalpel(3 cases of nonfunctioning parathyroid cyst and 7 cases of parathyroid adenoma accompanying hyperparathyroidism).Results The operation was successfully accomplished in all the 10 cases,without conversions to open surgery.The operative time was 20～70 min(mean,40 min).No hoarseness,choking cough,or hemorrhage occurred.A transient hypocalcemia developed in 3 cases.All the patients were followed for 2～18 months(mean,9 months),with satisfactory curative and cosmetic results.Conclusions Minimally invasive video-assisted parathyroidectomy appears to be a safe and effective treatment with good cosmetic results and postoperative outcomes.

Parathyroid Cysts / 대한내분비학회지

The parathyroid cyst is a relatively uncommon disease and usually identified during the operation for a presumed thyroid mass. Thirteen cases of parathyroid cyst (2 males, 11 females) treated from 1981 to 1993 were reviewed. Ages ranged from 17 to 59 years(mean, 41 years). Gross measurement of the tumor size varied from 1.0 to 10.0 cm in diameter with a mean of 4.8cm. All of the 13 patients presented with a chief complaint of painless anterior cervical mass. Only one complained of mild symptom of dyspnea and voice change due to huge cyst in paratracheal space. No functional cyst was identified. Diagnostic studies included