Current Review
Mediastinal parathyroid cysts revisited

https://doi.org/10.1016/S0003-4975(99)00018-1Get rights and content

Abstract

Background. A case of a functioning mediastinal cyst is presented.

Methods. A comprehensive review of the literature found 93 patients in whom a parathyroid cyst or cysts extended into, or was completely contained within, the mediastinum. Including our patient, there were 46 men and 45 women, and the gender was not recorded in three.

Results. The cysts were located in the anterosuperior region in 56 patients, in the middle region of the mediastinum in 26, and in the anterior, prevascular region in 12. Thirty-nine patients had functioning cysts associated with hyperparathyroidism of varying severity; seven patients presented with a hypercalcemic crisis. Local symptomatology consisted of a neck mass, respiratory distress, and occasional dysphagia or chest pain. Recurrent laryngeal nerve paresis was present in nine patients, and innominate vein compression or thrombosis was present in two. The cysts in all but four patients were treated by open surgical excision; two were treated by thoracoscopy, and two patients only had fine-needle aspiration of the cyst. The cyst was excised via a cervical approach in 67 patients and by a thoracotomy or median sternotomy or a variation thereof in 23. There was no operative mortality and morbidity was minimal.

Conclusion. Surgical resection was successful in all and remains the treatment of choice for mediastinal parathyroid cysts.

Section snippets

Material and methods

In reviewing the literature relative to mediastinal parathyroid cysts, it became apparent that many conflicting statements have been made regarding the number, anatomic location, and clinical presentation of these cysts. Not only is this true among the many reviews, but misstatements have occurred in individual reports as well. To clarify the conflicting data, we reviewed the potentially pertinent literature that has been published since De Quervain’s report in 1925 until December 31, 1997.

Results

Ninety-four patients with a mediastinal parathyroid cyst or cysts as defined, including the patient presented in this report, were identified. In 56 patients (59.5%), 59 cysts were located or partially descended into the anterosuperior space (Table 1). In 26 patients (27.6%), the cyst was in the middle compartment (Table 2). In 12 patients (12.7%), the cyst descended into (2 patients) or was completely contained (10 patients) within the anterior mediastinal space (Table 3). In this latter group

Comment

There are many theories concerning the origin of parathyroid cysts, including (1) fluid gradually accumulates within a parathyroid gland to form a retention cyst [78, 79]; (2) they have been suggested to be derived from vestigial remnants of the Kürsteiner canals [80, 81]; (3) the cyst is formed by the coalescence of preexisting microcysts that have been described in 50% of the parathyroid glands at autopsy [82, 83]; (4) they develop from embryologic remnants of the third or fourth branchial

Addendum

Two additional case reports of parathyroid cyst have appeared in the Japanese literature since the closing date of this report (December 31, 1998). Hattori and associates (J Jpn Assoc Chest Surg 1998;12:543–48) reported on a 51-year-old asymptomatic man who had a 3-cm, nonfunctioning cyst removed from the right side of the middle mediastinal compartment. Shibata and associates (J Jpn Assoc Chest Surg 1998;12:676–80) treated a 56-year-old asymptomatic man in whom a 3.5 × 3-cm, nonfunctioning

Acknowledgements

Dr. Ryosuki Tsuchia, National Cancer Center, Tokyo, Japan, and Professor Yoh Watanabe, Department of Surgery, Kanazawa University School of Medicine, Kanazawa, Japan, supplied and translated many of the Japanese publications that we could not obtain in the United States. For this we are grateful because their help permitted us to present a more complete review of the literature.

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    Copyright © 1999 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.