Giant mediastinal parathyroid cyst: an unusual cause of hypercalcemic crisis--case report and review of the literature

Abstract

Background: Cysts of the parathyroid gland located in the mediastinum are rare but well-defined clinical and pathologic entities. Since the first case report in 1925 a total of 28 mediastinal parathyroid cysts have been reported.

Methods and results: An 83-year-old woman with acute hypercalcemic crisis is reported. The patient had a giant mediastinal parathyroid cyst. Her symptoms resolved completely after the cystic tumor was resected. The case is discussed, and the world literature is reviewed.

Conclusions: Hypercalcemic crisis is a rare but potentially fatal complication of hyperparathyroidism. Resection of the parathyroid tumor results in prompt recovery. A thorough bilateral neck exploration should be performed after the patient's condition is stabilized. Mediastinal exploration is indicated at the initial operation, if a parathyroid tumor is not present in the neck or is not accessible through a cervical incision. Localization studies can be done before the operation in patients with hyperparathyroid crisis, but the results of localization studies should not preclude a thorough surgical exploration.