This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Otolaryngology/ Head & Neck Surgery  • Endocrine Surgery  • Endocrine Diseases  • Thyroid/ Parathyroid Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Functional and Nonfunctional Parathyroid Cysts

Kelly L. McCoy, MD; John H. Yim, MD; Brian S. Zuckerbraun, MD; Jennifer B. Ogilvie, MD; Robert L. Peel, MD; Sally E. Carty, MD

Arch Surg. 2009;144(1):52-56.

Hypothesis  Functional parathyroid cysts (FPCs) and nonfunctional parathyroid cysts (NPCs) are 2 distinct clinical and histologic entities.

Design  Review of prospective clinical database records.

Setting  Tertiary academic center.

Patients  Patients enrolled in a prospective surgical database between January 1, 1990, and May 31, 2007.

Intervention  Cervical exploration for primary hyperparathyroidism or cervical mass.

Main Outcome Measures  Age, sex, morbidity, imaging results, pathologic findings, cyst characteristics (size, location, and fluid), and perioperative calcium and parathyroid hormone levels.

Results  Cystic parathyroid lesions were found in 48 of 1769 patients (3%) studied. Functional parathyroid cysts were more common than NPCs, arising in 41 of 48 patients (85%), and showed no predisposition for sex or embryologic origin. Single-photon emission computed tomographic imaging failed to localize FPCs in 12 of 37 patients (32%). The fluid in FPCs was clear or colorless in 9 of 15 characterized specimens (60%). Rupture of cystic parathyroid lesions during resection was associated with prolonged elevation of intraoperative parathyroid hormone levels (P =.045). Cystic parathyroid lesions weighing 4 g or more were associated with the development of postoperative symptomatic hypocalcemia (P =.03). Functional parathyroid cysts occurred exclusively in adenomas with cystic change, whereas NPCs (with 1 exception) were without associated adenoma on final histologic examination.

Conclusions  Cystic parathyroid lesions often contain turbid or colored fluid, and FPCs are more common than NPCs. Neck cysts of uncertain origin should be diagnostically aspirated for parathyroid hormone content. During resection, cyst rupture should be avoided, and patients with large cysts should be managed expectantly to forestall the development of symptomatic hypocalcemia. Functional parathyroid cysts and NPCs are likely 2 separate clinical and histologic entities.

Author Affiliations: Departments of Surgery (Drs McCoy, Yim, Zuckerbraun, Ogilvie, and Carty) and Pathology (Drs Peel and Carty), School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Cystic Parathyroid Lesions—Invited Critique
Orlo H. Clark
Arch Surg. 2009;144(1):56.
EXTRACT | FULL TEXT