{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:16:45Z","timestamp":1784557005594,"version":"3.55.0"},"reference-count":20,"publisher":"Bioscientifica","content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,10,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Parathyroid cystic adenomas are often misdiagnosed as thyroid cysts and routine preoperative diagnostic tools, such as ultrasonography (US) or 99m technetium-sestamibi (99mTc-MIBI) scans, cannot clearly distinguish between these entities. We present a 67-year-old hypercalcemic woman with a cervical cystic lesion who had negative sestamibi scan results. Her laboratory data indicated primary hyperparathyroidism (serum calcium concentration 14.0\u200amg\/dl, phosphate concentration 2.3\u200amg\/dl, and intact parathyroid hormone (PTH) concentration 239\u200apg\/ml). The cervical US and computed tomography scans revealed a large and vertically long cystic mass (12\u00d711\u00d754\u200amm). A mass was located from the upper end of the left thyroid lobe to the submandibular region and was not clearly distinguishable from the thyroid. For preoperative definitive diagnosis, we carried out a parathyroid fine-needle aspiration (FNA) and PTH assay (PTH\u2013FNA) of liquid aspirated from the cyst. The intact PTH\u2013FNA concentration was 1.28\u00d710\n                    <jats:sup>6<\/jats:sup>\n                    pg\/ml, and the patient was diagnosed with primary hyperparathyroidism due to a cystic mass. She underwent a left upper parathyroidectomy and her serum calcium and intact PTH concentration immediately decreased to normal levels. This report describes the usefulness of PTH\u2013FNA for localizing and differentiating an atypical functional parathyroid lesion from nonfunctional tissue in primary hyperparathyroidism.\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Cystic parathyroid lesions, even in the case of elevated PTH levels, can produce negative results in 99mTc-MIBI scans.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Preoperative diagnosis of parathyroid cysts detectable on US is possible by parathyroid FNA and PTH assay (PTH\u2013FNA) of liquid aspirated from the cyst, if malignancy is not suspected.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>PTH\u2013FNA could be helpful in the differential diagnosis of an equivocal cervical tumor.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/edm-14-0086","type":"journal-article","created":{"date-parts":[[2014,10,16]],"date-time":"2014-10-16T09:50:25Z","timestamp":1413453025000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["Primary hyperparathyroidism due to atypical vertically long cystic adenoma"],"prefix":"10.1530","volume":"2014","author":[{"given":"Sachiko-Tsukamoto","family":"Kawashima","sequence":"first","affiliation":[{"name":"1 Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan"},{"name":"2 Department of Diabetes, Endocrinology and Metabolism Tango Central Hospital, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Usui","sequence":"additional","affiliation":[{"name":"3 Clinical Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Ueda","sequence":"additional","affiliation":[{"name":"1 Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maiko-Kakita","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"1 Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Tsuiki","sequence":"additional","affiliation":[{"name":"1 Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanako","family":"Tanase-Nakao","sequence":"additional","affiliation":[{"name":"1 Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazutaka","family":"Nanba","sequence":"additional","affiliation":[{"name":"1 Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Tagami","sequence":"additional","affiliation":[{"name":"1 Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuhide","family":"Naruse","sequence":"additional","affiliation":[{"name":"3 Clinical Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Watanabe","sequence":"additional","affiliation":[{"name":"4 Department of Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Asato","sequence":"additional","affiliation":[{"name":"4 Department of Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumiko","family":"Kato","sequence":"additional","affiliation":[{"name":"5 Osaka Saiseikai Ibaraki Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Shimatsu","sequence":"additional","affiliation":[{"name":"3 Clinical Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref151","doi-asserted-by":"crossref","first-page":"2272","DOI":"10.1245\/s10434-012-2325-3","article-title":"Primary hyperparathyroidism and negative Tc99 sestamibi imaging: to operate or not?","volume":"19","year":"2012","journal-title":"Annals of Surgical Oncology"},{"key":"ref161","first-page":"Article ID: 130019","article-title":"Needle aspirate PTH in diagnosis of primary hyperparathyroidism due to intrathyroidal parathyroid cyst","year":"2012","journal-title":"Endocrinology, Diabetes & Metabolism Case Reports"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1001\/archotol.132.7.779","article-title":"Technetium Tc 99m sestamibi sensitivity in oxyphil cell-dominant parathyroid adenomas","volume":"132","year":"2006","journal-title":"Archives of Otolaryngology--Head & Neck 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