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We speculate that the cause of our patient's decompensation was cystic degeneration of a preexisting adenoma. The histopathologic characteristics of parathyroid cysts are usually a smooth inner surface wall with a thin, tough membranous lining.typical cystic parathyroid adenomas are a rare clinical entity. Atypical adenomas exhibit some pathologic features of carcinoma, but they lack the indisputable evidence of a malignant lesion, such as angioinvasion or metastatic involvement.
Technetium-99m-sestamibi SPECT findings, surgical and pathologic reports, and the results of parathyroid hormone assay of the cyst fluid also were reviewed. RESULTS: Most of the cystic adenomas (14/15, 93%) were deep or inferolateral to the adjacent thyroid.The same percentage were elongated and had peripheral nodular components. An echogenic border separating the adenoma from the overlying thyroid was identified in 9 of 15 patients (60%).ix of 14 patients underwent preoperative or intraoperative sampling of cyst fluid, and the assay showed the parathyroid hormone levels ranged from 1,198 to greater than 5,000 pg/mL. Fourteen of 15 patients underwent preoperative sestamibi SPECT, and the adenoma was definitively localized in four patients (29%).