Abstract

IntroductionFunctioning mediastinal parathyroid cysts are extremely rare. Technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI) scintigrams usually helps to localize parathyroid lesions, but we report a case with no MIBI uptake. Presentation of caseA 79-year-old woman with lower extremity edema and dysphagia was referred to our hospital. Her blood calcium (Ca) level was 11.1 mg/dl, and the intact parathyroid hormone (PTH) level was 132 pg/ml. Computed tomography showed a 3.5 cm solid nodule in the right thyroid lobe and a 5.4 cm cystic mass extending to the mediastinum. The 99mTc-MIBI scintigram showed abnormal uptake in the thyroid nodule but no uptake in the mediastinal mass. The diagnosis was a thyroid nodule in the right lobe, primary hyperparathyroidism and a mediastinal mass. Under general anesthesia, the thyroid nodule and the mediastinal mass were resected via a cervical incision. The right lower parathyroid gland was resected because it measured about 1 cm and had the dark red color of a parathyroid adenoma. The pathological diagnoses were adenomatous goiter, normal parathyroid gland and mediastinal parathyroid cystic adenoma. The histopathological examination of the mediastinal mass showed a uniform population of parathyroid cells. The postoperative serum Ca and intact-PTH levels were normal. There has been no relapse. Discussion and ConclusionPatients with parathyroid cysts sometimes have negative 99mTc-MIBI scans. We should consider a parathyroid cyst when a mediastinal cystic mass is demonstrated. Surgical resection is thought to be the optimal therapeutic choice for mediastinal parathyroid cysts irrespective of functioning because mediastinal parathyroid cysts are large and produce compressive symptoms.

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