Parathyroid adenoma in third pharyngeal pouch cyst as a rare case of primary hyperparathyroidism

Ann R Coll Surg Engl. 2014 Oct;96(7):e8-10. doi: 10.1308/003588414X13946184900804.

Abstract

The primitive thymus and inferior parathyroid derive from the third branchial cleft. During embryonic development, these structures descend, reaching their final localisation. Third branchial cleft anomalies present usually as a fistula, abscess or cyst. However, there are no reports on parathyroid adenomas in the literature other than as a morphological possibility. We describe the case of a 47-year-old man, who had been diagnosed with arterial hypertension and who presented with a cervical mass at the edge of the lower third of the sternocleidomastoid muscle. On ultrasonography, the mass had a cystic walled appearance. Laboratory analysis only revealed an intact parathyroid hormone level of 140.5 pg/ml. Sestamibi imaging showed a probable parathyroid adenoma in the anterior mediastinum. During surgery, a tract running from beyond the superior thyroid pedicle to the superior mediastinum was dissected and removed. In the inferior end of the tract, a brown mass was visible. Pathological examination revealed a thymus cyst surrounding a parathyroid adenoma. The primal alteration was the lack of division between the thymus and inferior parathyroid gland, and the prompt prevention of their development. In the case of our patient, a parathyroid adenoma had grown by chance.

Publication types

  • Case Reports

MeSH terms

  • Adenoma / complications
  • Adenoma / diagnostic imaging*
  • Adenoma / surgery
  • Contrast Media
  • Cysts / complications
  • Cysts / diagnostic imaging
  • Follow-Up Studies
  • Humans
  • Hyperparathyroidism / diagnostic imaging
  • Hyperparathyroidism / etiology*
  • Hyperparathyroidism / surgery
  • Male
  • Middle Aged
  • Parathyroid Neoplasms / complications
  • Parathyroid Neoplasms / diagnostic imaging*
  • Parathyroid Neoplasms / surgery
  • Parathyroidectomy / methods*
  • Pharyngeal Diseases / complications
  • Pharyngeal Diseases / diagnostic imaging
  • Rare Diseases
  • Risk Assessment
  • Technetium Tc 99m Sestamibi
  • Thoracotomy / methods
  • Treatment Outcome
  • Ultrasonography, Doppler / methods

Substances

  • Contrast Media
  • Technetium Tc 99m Sestamibi