Cystic parathyroid macroadenoma or esophageal duplication cyst? A rare presentation of a common pathology

A 53-year-old woman was diagnosed with primary hypercalcemic hyperparathyroidism, which was not located by ultrasound or SPECT.

Choline PET was performed, which raised doubts about the diagnosis as it revealed a 3-cm lesion with a hypodense center and peripheral uptake, which are non-specific characteristics of parathyroid adenoma (Fig. 1). Upon completion of the study with CT and endoscopic ultrasound, a differential diagnosis was proposed with a rare entity, esophageal duplication cyst (Fig. 2).

Figure 1.

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Figure 2.

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Bilateral cervical exploration was performed, which revealed a 6.6-g macroadenoma.

Although complementary studies may show discordant findings, it is more likely to find a rare presentation of a common entity than an exotic pathology.