Cervical Parathyroid Cyst

Cysts of the parathyroid glands, like thymic cysts, have several characteristic morphologic features, including a persistent hollow tract with the third or fourth branchial pouch. It is estimated that 5% of neck cysts or fewer are parathyroid in origin. Few parathyroid cysts have been reported in childhood, implying that most are acquired, including cystic parathyroid adenoma.

There appear to be two distinct types of parathyroid cysts: non-functioning and functioning. The former make up the majority of these cysts and are about two to three times more common in women than in men. The mean age of patients with a non-functioning cyst is 43.3 years. Functioning cysts account for 11.5 to 30% of these cysts [48]. They are more common in men by a ratio of 1.6:1 and tend to occur in sites other than the inferior parathyroid glands, from the angle of the mandible to the mediastinum [120]. The mean age of patients with functioning cysts is 51.9 years.

About 95% of these cysts occur below the inferior thyroid border, and 65% are associated with the inferior parathyroid glands. Cysts have been identified from the angle of the mandible to the mediastinum, however, and they can occur in the thyroid lobe or posteriorly [36].

Fine-needle aspiration is the principal diagnostic tool. Aspiration of clear fluid with an elevated parathy roid hormone level is a definite indication of a parathyroid cyst. The C-terminal/midmolecular zone of the parathyroid hormone should be assayed, because the N-terminal-specific assay is frequently associated with false-negative results [81].

Histologic studies show that a parathyroid cyst's wall is usually formed by a solitary layer of compressed cu-boidal or low columnar epithelium, with either chief or oxyphilic cells present in the fibrous capsule (Fig. 9.8). Some cysts may not have any identifiable parathyroid tissue, but even in these cases a diagnosis can be established by testing the cystic fluid. Immunostaining for parathyroid hormone could be of help.

Aspiration may be curative, but persistence or recurrence of the cyst is a sign that surgical removal is in order. Functional cysts are associated with a high risk of other parathyroid gland abnormalities such as hyperplasia or adenoma [92].

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