title: Functional giant parathyroid cyst with high concentration of CA19-9 in cystic fluid.
abstract: A 63-year-old man was admitted to our hospital for the evaluation of hypercalcemia and anterior neck mass. Laboratory findings revealed hypercalcemia, hypophosphatemia, and hypercalciuria, as well as elevated serum levels of parathyroid hormone (PTH) and alkaline phosphatase. Computerized tomography and magnetic resonance images showed that the mass contained a cystic area. Parathyroid scintigraphy using either 99mTc-sestamibi alone or 201Tl-chloride in conjunction with 99mTc-pertechnetate for thyroid image subtraction showed uptake of the radioactivity into the cyst wall, suggesting that the mass originated from the parathyroid. Fine needle aspiration biopsy revealed that the cyst fluid was serous and bloody with extremely high concentrations of both PTH and CA19-9. The patient was diagnosed as primary hyperparathyroidism caused by parathyroid cyst and cervical exploration was performed. The cyst was dissected away along with the right lobe of the thyroid gland. After tumor removal, serum calcium and PTH levels were normalized. Histological study showed that the tumor possessed malignant potential with capsular invasion as well as moderate cellular atypia with trabecular pattern in arrangement. Parathyroid cells in the wall of the cystic tumor were immunostained positively for CA19-9, suggesting that CA19-9 in the cyst fluid was produced from the cells.
authors.affiliation: Division of Endocrinology/Metabolism, Neurology and Hematology/Oncology, Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Makino
authors.forename: Toshitsugu
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kaji
authors.forename: Toru
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Riko
authors.initials: R
authors.lastname: Kitazawa
authors.forename: Mika
authors.initials: M
authors.lastname: Yamauchi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Sowa
authors.forename: Qingxiang
authors.initials: Q
authors.lastname: Chen
authors.forename: Rikako
authors.initials: R
authors.lastname: Nomura
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chihara
mesh_terms: D018395:CA-19-9 Antigen / Q000378:metabolism*; D003560:Cysts / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D010279:Parathyroid Diseases / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology; D011877:Radionuclide Imaging; D014057:Tomography, X-Ray Computed
chemical_list: D018395:CA-19-9 Antigen