Cystic parathyroid lesion: case report of rare entity.

Introduction and importance: Parathyroid cysts are rarely encountered in neck surgery and often misdiagnosed. We review the case incidence and treatment of parathyroid cystic lesions among all neck procedure in two single institutions operated on by a single surgeon. Case presentation: We report two female patients presenting with neck swallowing, dysphagia, choking and occasional dysphonia. Ultrasound US (ultrasound) imaging revealed two neck masses of 66 × 44 mm and 44 × 25 × 23 mm; serum iPTH (intact Parathyroid Hormone) levels were 238 and 699 ng/mL respectively and sestamibi scintiscan results were negative for both masses. Intra-cystic fluid evaluation of PTH showed elevated value (>5000 ng/ml). Both patients underwent parathyroidectomy along with total thyroidectomy and thyroid lobectomy. Post-operatively I-PTH and serum calcium levels became normal. Final histology confirmed a benign parathyroid cystic adenoma with concomitant benign thyroid disease. Clinical discussion: Parathyroid cyst is of rare entity and a diagnostic challenge. Conclusions: This case report demonstrates that fine needle aspiration (FNA) fluid with intra-cystic parathyroid analysis shows to be fundamental and supports surgery for hyperparathyroidism resolution.