Cystic Neck Mass | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Cystic Neck Mass in a Middle-aged Woman

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

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.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

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.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Daniel Gerges, MD, Division of Otolaryngology, University of Vermont Medical Center, 111 Colchester Ave, W Pavilion 4, Burlington, VT 05401 (dgerges779@gmail.com).

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.

References
1.
Papavramidis  TS , Chorti  A , Pliakos  I , Panidis  S , Michalopoulos  A .  Parathyroid cysts: a review of 359 patients reported in the international literature.   Medicine (Baltimore). 2018;97(28):e11399. doi:10.1097/MD.0000000000011399 PubMedGoogle Scholar
2.
Rossi  ED , Revelli  L , Giustozzi  E ,  et al.  Large non-functioning parathyroid cysts: our institutional experience of a rare entity and a possible pitfall in thyroid cytology.   Cytopathology. 2015;26(2):114-121. doi:10.1111/cyt.12153 PubMedGoogle ScholarCrossref
3.
McCoy  KL , Yim  JH , Zuckerbraun  BS , Ogilvie  JB , Peel  RL , Carty  SE .  Cystic parathyroid lesions: functional and nonfunctional parathyroid cysts.   Arch Surg. 2009;144(1):52-56. doi:10.1001/archsurg.2008.531 PubMedGoogle ScholarCrossref
4.
Coste  AH , Lofgren  DH , Shermetaro  C . Branchial cleft cyst. StatPearls Publishing; 2021. Accessed August 12, 2021. https://www.ncbi.nlm.nih.gov/books/NBK499914/
5.
Allard  RH .  The thyroglossal cyst.   Head Neck Surg. 1982;5(2):134-146. doi:10.1002/hed.2890050209 PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close