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Mediastinum

Cystic lesions

Parathyroid cyst

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 24 February 2013, last major update December 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Rare causes of neck swelling accounting for 0.6% of thyroid and parathyroid lesions (Br J Hosp Med (Lond) 2012;73:108)
● Derived from third and fourth branchial pouch, as does thymus
● Cysts may be present in low cervical or anterosuperior mediastinum

Clinical features
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● Pure cysts are present at any age; contain high levels of parathyroid hormone; can diagnose by FNA via PTH in fluid (Am J Clin Pathol 1986;86:776)
● Patients usually are normocalcemic and present with an asymptomatic mass on Xray

Case reports
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● 46 year old woman with thyroid nodule (Indian J Pathol Microbiol 1996;39:297)
● 50 year old woman with neck mass (Med Ultrason 2011;13:157)
● 66 year old man with a palpable neck mass and hypercalcemia (West J Med 1999;170:118)

Gross description
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● 1-10 cm, unilocular, thin walled, clear fluid, no nodules

Micro description
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● Lined by flattened parathyroid chief cells, oxyphils, clear cells
● Cyst wall has uniform thickness
● May contain granular material resembling colloid
● No cholesterol granulomas, no cartilage, no smooth muscle

Micro images
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Giant cystic parathyroid adenoma

Positive stains
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● Chromogranin A, glycogen, parathyroid hormone

Negative stains
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● Thyroglobulin

Differential diagnosis
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● Parathyroid adenoma with secondary cystic change (J Clin Endocrinol Metab 2006;91:1635)
● Heterotopic salivary gland like tissue: see Am J Surg Pathol 2000;24:837

End of Mediastinum > Cystic lesions > Parathyroid cyst

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