The importance of multimodality imaging in diagnosing cystic parathyroid gland hyperplasia: a case report and systematic review

Supit, Nina ISH and Purwoto, Johanes and Adham, Marlinda and Gultom, Fajar Lamhot and Sulay, Callistus Bruce Henfry and Octavius, Gilbert Sterling (2024) The importance of multimodality imaging in diagnosing cystic parathyroid gland hyperplasia: a case report and systematic review. Egyptian Journal of Radiology and Nuclear Medicine, 55 (211). pp. 1-9. ISSN 2090-4762

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Abstract

Background Parathyroid cysts account for a small percentage of parathyroid lesions and are more prevalent in females. Cystic parathyroid hyperplasia is exceptionally rare, with only two cases reported thus far. This case report provides the readers with the frst multimodality imaging in cystic parathyroid hyperplasia as well as the authors’ frst experience in using a 4D computed tomography (CT) scan in our institution while the systematic review will comprehensively search and present similar cases. Main text The literature search started and ended on August 4, 2024. We searched fve academic databases: MEDLINE, Cochrane Library, Pubmed, Science Direct, and Google Scholar. The studied population was all patients with cystic parathyroid gland hyperplasia, confrmed by histopathology. A total of 205 articles were initially identifed, out of which 29 duplicates were promptly eliminated, leaving 176 unique articles for screening. Following the evaluation of titles and abstracts, ultimately only two studies were included in the systematic review. A 61-year-old male presented with recurrent abdominal pain and weight loss. Ultrasound revealed a left neck mass, cystic. The laryngeal CT scan agreed with the ultrasound while the Technetium-99 sestamibi scan suggested a thyroid lesion. A 4D CT scan confrmed a lobulated cystic lesion in the left parathyroid region. The patient underwent successful surgery, and histopathology confrmed parathyroid hyperplasia with a pseudocyst appearance. Conclusions This case report presents the frst imaging multimodality in cystic parathyroid hyperplasia while highlighting the rarity of this case, with two cases worldwide. In addition, this article describes our institution’s frst experience with a 4D CT scan. Keywords Cystic parathyroid hyperplasia, Hyperparathyroidism, Four-dimensional CT scan, Indonesia, Ultrasound

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