Parathyroid cyst eclipsed by parathyroid adenoma: Value of adjunct imaging

Khyati Bhatia; Deepak Sarin; Gopal Kumar Singh; Alka Ashmita Singhal

doi:10.4103/ijri.IJRI_458_19

Indian Journal of Radiology and Imaging, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2020; 30(04): 524-528
DOI: 10.4103/ijri.IJRI_458_19

Case Report

Parathyroid cyst eclipsed by parathyroid adenoma: Value of adjunct imaging

Authors

Khyati Bhatia

Departments of ENT and Head and Neck Surgery, Medanta, The Medicity, Gurgaon, Haryana, India
Deepak Sarin

Departments of Head and Neck Oncosurgery, Medanta, The Medicity, Gurgaon, Haryana, India
Gopal Kumar Singh

Departments of Head and Neck Oncosurgery, Medanta, The Medicity, Gurgaon, Haryana, India
Alka Ashmita Singhal

Departments of Radiology and Nuclear Imaging, Medanta, The Medicity, Gurgaon, Haryana, India

Abstract

Parathyroid cyst is a rare clinical entity and often presents as a diagnostic challenge, especially when presents in conjunction with a coexistent parathyroid adenoma. Patient with primary hyperparathyroidism had presented with a localised left inferior parathyroid adenoma with a coexistent right inferior parathyroid cyst which was initially missed on routine ultrasound and sestamibi scan. Suspicion of right inferior thyroid cyst was raised on ultrasound done by a dedicated parathyroid ultrasonologist. Right inferior thyroid cyst was confirmed to be parathyroid cyst on histopathological examination. Parathyroid cysts are seldom picked on sestamibi due to compressed parathyroid tissue present only at the periphery of the cyst. Hence, use of adjunct anatomical imaging like ultrasound, CT scan or MRI is worthwhile to reduce chances of missing hyperfunctional parathyroid tissue, which can eventually lead to revision surgery for persistent primary hyperparathyroidism.

Keywords

Parathyroid adenoma - parathyroid cyst - sestamibi - ultrasound

Volltext

Referenzen

References
1 Cappelli C, Rotondi M, Pirola I, De Martino E, Leporati P, Magri F. et al. Prevalence of parathyroid cysts by neck ultrasound scan in unselected patients. J Endocrinol Invest 2009; 32: 357-9
2 Nardi CE, Silva RA, Serafim CM, Dedivitis RA. Nonfunctional parathyroid cyst: Case report. Sao Paulo Med J 2009; 127: 382-4
3 Delbridge LW, Younes NA, Guinea AI, Reeve TS, Clifton-Bligh P, Robinson BG. Surgery for primary hyperparathyroidism 1962-1996: Indications and outcomes. Med J Aust 1998; 168: 153-6
4 Irvin 3rd GL, Solorzano CC, Carneiro DM. Quick intraoperative parathyroid hormone assay: Surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome. World J Surg 2004; 28: 1287-92
5 Rosenberg J, Orlando 3rd R, Ludwig M, Pyrtek LJ. Parathyroid cysts. Am J Surg 1982; 143: 473-80
6 Clark OH. Parathyroid cysts. Am J Surg 1978; 135: 395-402
7 Ippolito G, Palazzo FF, Sebag F, Sierra M, De Micco C, Henry JF. A single-institution 25-year review of true parathyroid cysts. Langenbecks Arch Surg 2006; 391: 13-8
8 Lee SL. Parathyroid cyst fluid: Discrepancy between C-terminal and intact parathyroid hormone assays. Thyroid 2000; 10: 1125-6
9 El-Housseini Y, Hübner M, Boubaker A, Bruegger J, Matter M, Bonny O. Unusual presentations of functional parathyroid cysts: A case series and review of the literature. J Med Case Rep 2017; 11: 333
10 Rossi ED, Revelli L, Giustozzi E, Straccia P, Stigliano E, Lombardi CP. et al. Large non-functioning parathyroid cysts: Our institutional experience of a rare entity and a possible pitfall in thyroid cytology. Cytopathology 2015; 26: 114-21
11 Pontikides N, Karras S, Kaprara A, Cheva A, Doumas A, Botsios D. et al. Diagnostic and therapeutic review of cystic parathyroid lesions. Hormones (Athens) 2012; 11: 410-8
12 Kaplanoglu V, Kaplanoglu H, Ciliz DS, Duran S. A rare cystic lesion of the neck: Parathyroid cyst. BMJ Case Rep 2013; 2013: bcr2013200813
13 Calandra DB, Shah KH, Prinz RA, Sullivan H, Hofmann C, Oslapas R. et al. Parathyroid cysts: A report of eleven cases including two associated with hyperparathyroid crisis. Surgery 1983; 94: 887-92
14 Ujiki M, Sturgeon C, Nayar R, Angelos P. Parathyroid cyst: Often mistaken for a thyroid cyst. World J Surg 2008; 32: 1234
15 Hughes CR, Kanmaz B, Isitman AT, Akansel G, Lawson T, Collier BD. Misleading imaging results in the diagnosis of parathyroid cysts. Clin Nucl Med 1994; 19: 422-5
16 Guner A, Karyagar S, Ozkan O, Kece C, Reis E. Parathyroid cyst: The forgotten diagnosis of a neck mass. J Surg Case Rep 2011; 2011: 4
17 Goomany A, Rafferty A, Smith I. An unusual neck mass: A case of a parathyroid cyst and review of the literature. Case Rep Surg 2015; 2015: 243527
18 Wright JG, Brangle RW. Carcinoma in a parathyroid cyst. IMJ Ill Med J 1985; 168: 98-100
19 Pirundini P, Zarif A, Wihbey JG. A rare manifestation of parathyroid carcinoma presenting as a cystic neck mass. Conn Med 1998; 62: 195-7
20 McCoy KL, Yim JH, Zuckerbraun BS, Ogilvie JB, Peel RL, Carty SE. Cystic parathyroid lesions: Functional and nonfunctional parathyroid cysts. Arch Surg 2009; 144: 52-6 discussion 56
21 DeRaimo AJ, Kane RA, Katz JF, Rolla AP. Parathyroid cyst: Diagnosis by sonography and needle aspiration. AJR Am J Roentgenol 1984; 142: 1227-8
22 Prinz RA, Peters JR, Kane JM, Wood J. Needle aspiration of non-functioning parathyroid cysts. Am Surg 1990; 56: 420-2
23 Shi B, Guo H, Tang N. Treatment of parathyroid cysts with fine-needle aspiration. Ann Intern Med 1999; 131: 797-8
24 Sánchez A, Carretto H. Treatment of a nonfunctioning parathyroid cyst with tetracycline injection. Head Neck 1993; 15: 263-5
25 Akel M, Salti I, Azar ST. Successful treatment of parathyroid cyst using ethanol sclerotherapy. Am J Med Sci 1999; 317: 50-2
26 Fortson JK, Patel VG, Henderson VJ. Parathyroid cysts: A case report and review of the literature. Laryngoscope 2001; 111: 1726-8