Skip to main content
SpringerLink
Log in

A single-institution 25-year review of true parathyroid cysts

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Parathyroid cysts (PCs) are rare, and their origin is a subject of debate. They have been described as either functional, causing hyperparathyroidism, or non-functional in eucalcaemic patients.

Patients and methods

We have performed a 25-year departmental review of PCs. Features studied included the clinical presentation and intra-operative findings, and a histological review was performed. Cases of cystic degeneration of parathyroid adenomas and pseudocystic change were excluded.

Results

Over 25 years, 22,009 thyroidectomies and 2,505 parathyroidectomies were performed in our department. Amongst these, 38 non-functional PCs were documented in 37 patients. The mode of presentation included incidental findings on routine chest x-ray, compressive symptoms or an asymptomatic palpable neck mass. Aspiration was the initial treatment in 14 patients and was curative in 10 of these. Four out of 14 patients underwent surgical procedures for recurrence of the cyst that occurred 6 to 48 months after aspiration. In 27 patients, surgery was performed and all identified PCs were localized in the inferior parathyroid glands. Histologically, the cyst wall consisted in associations of lymphoid, muscular, thymic, salivary, adipose and mesenchymal tissues.

Conclusions

PCs are rare but should be included within the differential diagnosis of a neck lump. True PCs are non-functional. Pathological and immunohistochemical findings are suggestive of a branchial origin. Fine-needle aspiration may be curative and is diagnostic due to the characteristic appearance of the fluid and high PTH levels on assay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sandstrom I (1880) Om en Körtel hos menniskan och atskilliga doggdjus. Upsala Lläkarför Forhandl 14:441

    Google Scholar 

  2. Goris D (1905) Extirpation de trois lobules parathyroidiens kystiques. Ann Soc Belge Chir 5:394

    Google Scholar 

  3. Greene EK, Greene JM, Busch RC (1952) Unusual manifestations after removal of parathyroid cyst. JAMA 150:853

    CAS  Google Scholar 

  4. Delaunay T, Peillon C, Manouvrier JL, Deotto JF, Doucet J, Nicaise JM, Watelet J, Testart J (1990) Cysts of the parathyroid glands. Apropos of 6 cases. Ann Chir 44(3):231–235

    PubMed  CAS  Google Scholar 

  5. Silverman JF, Khazanie PG, Norris HT, Fore WW (1986) Parathyroid hormone (PTH) assay of parathyroid cysts examined by fine-needle aspiration biopsy. Am J Clin Pathol 86(6):776–780

    PubMed  CAS  Google Scholar 

  6. Shields TW, Immerman SC (1999) Mediastinal parathyroid cysts revisited. Ann Thorac Surg 67(2):581–590

    Article  PubMed  CAS  Google Scholar 

  7. Troster M, Hak-Fai Chiu HF, McLarty TD (1978) Parathyroid cysts: report of a case with ultrastructural observations. Surgery 83(2):238–242

    PubMed  CAS  Google Scholar 

  8. Armstrong J, Leteurtre E, Proye C (2003) Intraparathyroid cyst: a tumour of branchial origin and a possible pitfall for targeted parathyroid surgery. ANZ J Surg 73(12):1048–1051

    Article  PubMed  Google Scholar 

  9. Hoehn JG, Beahrs OH, Woolner LB (1969) Unusual surgical lesions of the parathyroid gland. Am J Surg 118(5):770–778

    Article  PubMed  CAS  Google Scholar 

  10. Haugen OA (1970) Parathyroid cysts. Acta Chir Scand 136(3):247–249

    PubMed  CAS  Google Scholar 

  11. Bondeson AG, Thompson NW (1991) Mediastinal parathyroid adenomas and carcinomas. In: Shields TW (ed) Mediastinal surgery. Lea and Febiger, Philadelphia, PA, pp 289–295

    Google Scholar 

  12. Coates G, Pearman K, Holl-Allen RT (1991) Recurrent nerve palsy due to parathyroid cyst. Int Surg 76(3):192–193

    PubMed  CAS  Google Scholar 

  13. Sen P, Flower N, Papesch M, Davis A, Spedding AV (2000) A benign parathyroid cyst presenting with hoarse voice. J Laryngol Otol 114(2):147–148

    Article  PubMed  CAS  Google Scholar 

  14. Gamondes JP, Maret G, Berger G, Brune J, Joud R (1978) Parathyroid adenoma of the upper mediastinum with blood-filled cyst causing dyspnoea. Nouv Presse Med 7(45):4149

    PubMed  CAS  Google Scholar 

  15. Taniguchi I, Maeda T, Morimoto K, Miyasaka S, Suda T, Yamaga T (2003) Spontaneous retropharyngeal hematoma of a parathyroid cyst: report of a case. Surg Today 33(5):354–357

    Article  PubMed  Google Scholar 

  16. Simcic KJ, McDermott MT, Crawford GJ, Marx WH, Ownbey JL, Kidd GS (1989) Massive extracapsular hemorrhage from a parathyroid cyst. Arch Surg 124(11):1347–1350

    PubMed  CAS  Google Scholar 

  17. Biaou O, Adjibabi W, Tchane IB, Hounkpe YY, Alamou S, Balle MC, Stoll D (2002) Parathyroid cervical hematoma: a case report. Rev Laryngol Otol Rhinol (Bord) 123(3):159–162

    CAS  Google Scholar 

  18. Jha BC, Nagarkar NM, Kochar S, Mohan H, Dass A (1999) Parathyroid cyst: a rare cause of anterior neck mass. J Laryngol Otol 113:73–75

    Article  PubMed  CAS  Google Scholar 

  19. Haid SP, Method HL, Beal JM (1967) Parathyroid cysts. Arch Surg 94:421

    PubMed  CAS  Google Scholar 

  20. Hughes CR, Kanmaz B, Isitman AT, Akansel G, Lawson T, Collier BD (1994) Misleading imaging results in the diagnosis of parathyroid cysts. Clin Nucl Med 19(5):422–425

    Article  PubMed  CAS  Google Scholar 

  21. Marsot-Dupuch K, Levret N, Pharaboz C, Robert Y, el Maleh M, Meriot P, Poncet JL, Chabolle F (1995) Congenital neck masses. Embryonic origin and diagnosis. Report of the CIREOL. J Radiol 76(7):405–415

    PubMed  CAS  Google Scholar 

  22. Crile G Jr, Perryman RG (1953) Parathyroid cysts. Surgery 34:151

    PubMed  Google Scholar 

  23. Clark OH (1978) Parathyroid cysts. Am J Surg 135(3):395–402

    Article  PubMed  CAS  Google Scholar 

  24. Chiménes H, Moreaux J, Lefrileux CH, Martin E, Bitan MA, Klotz HP (1963) Adénome parathyroïdien à symptomatologie rénale pure chez une femme enceinte. Guerison chirugicale. Dosage de la parathromone dans le liquide de l’ adénome kystique (Parathyroid adenoma with purely renal symptoms in a pregnant woman. Surgical cure. Estimation of parathormone in the cystic adenoma liquid). Ann Endocrinol (Paris) 24:642–649

    Google Scholar 

  25. Pacini F, Antonelli A, Lari R, Gasperini L, Baschieri L, Pinchera A (1985) Unsuspected parathyroid cysts diagnosed by measurement of thyroglobulin and parathyroid hormone concentrations in fluid aspirates. Ann Intern Med 102(6):793–794

    PubMed  CAS  Google Scholar 

  26. Hamy A, Masson S, Heymann MF, Visset J, Paineau J (2002) Parathyroid cyst. Report of ten cases. Ann Chir 127(3):203–207

    Article  PubMed  CAS  Google Scholar 

  27. Ihm PS, Dray T, Sofferman RA, Nathan M, Hardin NJ (2001) Parathyroid cysts: diagnosis and management. Laryngoscope 111(9):1576–1578

    Article  PubMed  CAS  Google Scholar 

  28. Shi B, Guo H, Tang N (1999) Treatment of parathyroid cysts with fine-needle aspiration. Ann Intern Med 131(10):797–798

    PubMed  CAS  Google Scholar 

  29. Prinz RA, Peters JR, Kane JM, Wood J (1990) Needle aspiration of nonfunctioning parathyroid cysts. Am Surg 56(7):420–422

    PubMed  CAS  Google Scholar 

  30. Kodama T, Obara T, Fujimoto Y, Ito Y, Yashiro T, Hirayama A (1987) Eleven cases of nonfunctioning parathyroid cyst. Significance of needle aspiration in diagnosis and management. Endocrinol Jpn 34(5):769–777

    PubMed  CAS  Google Scholar 

  31. Clark OH, Okerlund MD, Cavalieri RR, Greenspan FS (1979) Diagnosis and treatment of thyroid, parathyroid, and thyroglossal duct cysts. J Clin Endocrinol Metab 48(6):983–988

    Article  PubMed  CAS  Google Scholar 

  32. Okamura K, Ikenoue H, Sato K, Yoshinari M, Nakagawa M, Kuroda T, Fujishima M (1992) Sclerotherapy for benign parathyroid cysts. Am J Surg 163(3):344–345

    Article  PubMed  CAS  Google Scholar 

  33. Akel M, Salti I, Azar ST (1999) Successful treatment of parathyroid cyst using ethanol sclerotherapy. Am J Med Sci 317(1):50–52

    Article  PubMed  CAS  Google Scholar 

  34. Takeichi N, Dohi K, Matsumoto H, Nishiki M, Kishi N, Fujii T, Matsuyama T, Fujikura T, Ezaki H (1985) A parathyroid cyst effectively treated with a sclerosing agent. Jpn J Surg 15(5):405–407

    Article  PubMed  CAS  Google Scholar 

  35. Ryan WG, Dwarakanathan A (1986) Minor complication of thyroid cyst sclerosis with tetracycline injection. Arch Intern Med 146:201–202

    Article  PubMed  CAS  Google Scholar 

  36. Sanchez A, Carretto H (1993) Treatment of a nonfunctioning parathyroid cyst with tetracycline injection. Head Neck 15(3):263–265

    Article  PubMed  CAS  Google Scholar 

  37. Pirundini P, Zarif A, Wihbey JG (1998) A rare manifestation of parathyroid carcinoma presenting as a cystic neck mass. Conn Med 62(4):195–197

    PubMed  CAS  Google Scholar 

  38. Wright JG, Brangle RW (1985) Carcinoma in a parathyroid cyst. IMJ Ill Med J 168(2):98–100

    PubMed  CAS  Google Scholar 

  39. Rogers LA, Fetter BF, Peete WP (1969) Parathyroid cyst and cystic degeneration of parathyroid adenoma. Arch Pathol 88(5):476–479

    PubMed  CAS  Google Scholar 

  40. Calandra DB, Shah KH, Prinz RA, Sullivan H, Hofmann C, Oslapas R, Ernst K, Lawrence AM, Paloyan E (1983) Parathyroid cysts: a report of eleven cases including two associated with hyperparathyroid crisis. Surgery 94(6):887–892

    PubMed  CAS  Google Scholar 

  41. Forsyth D (1908) The parathyroid glands. Their pathology in man. Q J Med 1:287

    Google Scholar 

  42. Castelman B, Mallory TB (1935) The pathology of the parathyroid gland in hyperparathyroidism. Am J Pathol 11:1

    Google Scholar 

  43. Gilmour JR (1939) The normal histology of the parathyroid glands. J Pathol Bacteriol 48:187

    Article  Google Scholar 

  44. Kursteiner W (1899) Die epithelkorperchen des herschen in iher beziehung zur thyreoidea und thymus. Anat Hefte 11:391

    Article  Google Scholar 

  45. Moore KL (1973) The developing human. W.B. Saunders, Philadelphia

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrine Surgery, La Timone University Hospital, Marseille, France

    Giuseppe Ippolito, F. Fausto Palazzo, Frederic Sebag, Mauricio Sierra & Jean-François Henry

  2. Department of Pathology, Nord Hospital, Marseille, France

    Catherine De Micco

  3. Department of Surgery, La Timone Hospital, 264, Rue Saint-Pierre, 13385, Marseille, France

    Jean-François Henry

Authors
  1. Giuseppe Ippolito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Fausto Palazzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frederic Sebag
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mauricio Sierra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Catherine De Micco
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean-François Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-François Henry.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ippolito, G., Palazzo, F.F., Sebag, F. et al. A single-institution 25-year review of true parathyroid cysts. Langenbecks Arch Surg 391, 13–18 (2006). https://doi.org/10.1007/s00423-005-0579-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-005-0579-y

Keywords

Search

Navigation