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

• Published in: Annals of the Royal College of Surgeons of England Vol. 96; no. 7; pp. e8 - e10
• Main Authors: Salido, S, Gómez-Ramírez, J, Bravo, J M, Martín-Pérez, E, Fernández-Díaz, G, Múñoz de Nova, J L, Auza, J, Larrañaga, E
• Format: Journal Article
• Language: English
• Published: England Royal College of Surgeons 01.10.2014
• Subjects: 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; Online Case report; 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
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588414X13946184900804

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.