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A 44-year-old woman presented to the otolaryngology clinic with a 6-month history of a right neck mass with compressive symptoms. She first noticed swelling that progressed to pressure and dyspnea while supine. She reported fatigue but denied pain, voice change, weight loss, hemoptysis, and dysphagia. A physical examination revealed a visible and palpable fullness to the right neck without overlying cutaneous or sinus tract changes. Results of a complete blood cell count, a thyroid stimulating hormone test, triiodothyronine and levorotatory thyroxine testing, and a complete metabolic panel were normal. Ultrasonography showed a 7.9 × 6.3-cm septate cystic mass lateral to the right thyroid gland. A contrast-enhanced computed tomography scan of the neck demonstrated a large, nonenhancing cystic-appearing lesion abutting the lateral and posterior margins of the right thyroid lobe and extending from the level of the piriform sinus to the thoracic inlet (Figure). Ultrasound-guided fine-needle aspiration revealed clear fluid with a parathyroid hormone (PTH) level of 67 pg/mL (reference range, <100 pg/mL; to convert to ng/L multiply by 1.00). A barium swallow study showed no communication between the cyst and the piriform sinus. Excision in the operating room was performed, and right thyroid lobectomy was necessary because of the intimate association of the lesion to the thyroid lobe.
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C. Parathyroid cyst
Given the size of the cystic lesion and the compressive symptoms, the patient was taken to the operating room for excision. The mass was intimately associated with the right thyroid lobe as well as the recurrent laryngeal nerve, necessitating right thyroid lobectomy for complete excision of the lesion. Use of an intraoperative nerve monitoring system proved helpful in the removal of this lesion by aiding in identification and confirming integrity of the recurrent laryngeal nerve throughout the dissection. Histologically, the cyst was lined by a single layer of cuboidal cells and surrounded by islands of normal parathyroid parenchyma. These findings were consistent with a parathyroid cyst.
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Corresponding Author: Daniel Gerges, MD, Division of Otolaryngology, University of Vermont Medical Center, 111 Colchester Ave, W Pavilion 4, Burlington, VT 05401 (firstname.lastname@example.org).
Published Online: September 16, 2021. doi:10.1001/jamaoto.2021.2400
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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