A 51 years old lady with a ten-year history of an anterior neck lump, which slowly enlarged in size, complained of fatigue and slightly exertional dyspnea. The neck mass was approximately 10.0 × 7.5 × 5.0 cm. Conventional ultrasound reported a 9.9 × 7.0 × 4.9 cm cystic lesion inferior to the thyroid. The results of longitudinal and transverse contrast-enhanced computed tomography scans revealed a pretracheal 10.0 × 7.1 × 5.0 cm (craniocaudal × transverse × anteroposterior) oval-shaped cystic lesion which fell into the mediastinum and severely pushed the trachea to the left (Fig. 1 A, B). Thyroid and parathyroid function tests were within the reference ranges and the serum adjusted calcium was 2.28mmol/L. Fine-needle aspiration of the lump revealed clear fluid. Intraoperatively, a thin walled cyst arising from the right superior thyroid gland occupied the whole pretracheal position, which was filled with clear liquid. The lumps were easily separated from the surrounding tissues and were completely removed with the partial right thyroid lobe (Fig. 1 C). Because the intraoperative rapid pathologic examination could not prompt malignant lesions, the residual right thyroid lobe was retained to preserve thyroid function. Histopathological examination revealed a 10.0 cm diameter cystic abnormality with a fibrofatty wall lined by a low columnar epithelium arising from the right superior parathyroid gland (Fig. 1 D). Parathyroid tissue with no cellular atypia was identified focally within the cyst wall. The patient recovered steadily and was discharged on the fifth day after surgery. During the 2 years follow-up, the patient had no recurrence or serum biochemical abnormalities.
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