Cystic parathyroid lesions (CPL) account for I-5% of neck cysts. They are seldom palpable: however, they may present as neck swellings that are mistaken both clinically and cytologically for thyroid nodules and subsequentlv referred for evaluation by fine-needle aspiration. We present 4 cases of histologically confinned CPL {one simple cyst, one hyperplasia. and two adenomas), 2 of which were misdiagnosed as adenomatoid thyroid nodules by fine-needle aspiration. Aspirated fluid from one patient was clear and colorless. a classic finding for parathyroid cysts, and contained high levels of C-tenninaUmidmolecule parathyroid hormone (CUPH). Fluids obtained from the remaining 3 patients were bloody to brown. resembling thyroid cyst jluid. In only 1 of the 3 patients, the fluid was analyzed and contained high levels of CUPH. Though cytologic features of parathyroid epithelium overlap with those of thyroid epithelium, distinguishing features such as unusual cytoplasmic vac-UoliDtion and granularity and the absence of colloid. should raise suspicions of a parathyroid lesion. Fluid from CPL may not possess the classic appearance: however, identification of the subtler cytologic features with knowledge of relevant clinical data should prompt analysis of cvst fluid for CMPH, thus confirming the diagnosis and avoiding inappropriate therapy.