First branchial cleft anomalies are uncommon paediatric congenital lesions that may present as persistent pre-auricular or post-auricular sinuses and can involve the parotid region and facial nerve. We present a single-centre 10-year experience describing presentation, imaging, management and outcomes. Retrospective review of a prospectively collected local dataset of paediatric patients with first branchial arch cleft cysts/tracts who underwent evaluation and surgery at a tertiary paediatric centre. Data elements included age at presentation, presenting symptoms, imaging modality, surgical treatment, postoperative complications, facial nerve dysfunction, fistula course, recurrence and follow-up. Eleven patients were included (mean age 5.55 years, median 4 years). The commonest presentation was a persistent sinus with purulent discharge (9/11). Laterality was predominantly left-sided (8/11). MRI was the most used imaging modality (8/11). Postoperative wound infection occurred in 3/11 patients (27%); marginal mandibular branch weakness was recorded in 2/11 (both documented as transient/resolved). One patient had documented recurrence. The fistula/tract most commonly tracked from level II to the ear canal (9/11). In this paediatric series, first branchial arch cleft anomalies most commonly presented as persistent left-sided sinuses with purulent discharge. MRI was commonly used for preoperative assessment. Surgical excision was associated with wound infection in a minority and transient marginal mandibular weakness in several cases. Larger multi-centre series with systematic prospective follow-up are needed.

Branchial cleft cyst carcinomas (BCCC) are rare lateral neck malignancies thought to originate from branchial cleft remnants. Diagnosing primary BCCC should be approached with skepticism; cystic nodal metastasis must be excluded. Due to its rarity, we performed a comprehensive database study to better characterize the ongoing diagnosis of BCCC. Single-arm retrospective cohort study using the TriNetX Research database. Patients ≥ 18 years of age with a diagnosis of BCCC identified by ICD-10 C10.4 between 2008 and 2018 were included, allowing for up to 5 years of follow-up. Demographics, past medical history, oncologic history, diagnostic rate, treatment pathways, and 5-year outcomes including diagnosis with primary HNC and Kaplan-Meier survival curves were analyzed within TriNetX. In 10 years, 1070 patients diagnosed with BCCC were included. The mean age was 59.6 ± 9.7; the majority were male (n = 810, 75.6%) and white (n = 765, 71.4%). Incidence of BCCC increased from 2008 to 2015 and subsequently dropped precipitously. Almost all patients, 94.4% (n = 1011), had prior or subsequent diagnosis of another HNC within 5 years. Five-year survival probability for BCCC was 56.0%. We describe the largest cohort of BCCC patients to date. Most patients were diagnosed with another HNC within 5 years, suggesting a likely misdiagnosis of BCCC. A poor 5-year survival rate may be secondary to a delay in appropriate treatment following an erroneous diagnosis, underscoring the need to approach a diagnosis of BCCC with caution. We consider the use of the BCCC code to be detrimental and recommend its discontinuation.

A Rare Case of Lateral Cervical Cyst Infection Associated with Bacillus subtilis subsp. natto

Cystic neck masses constitute a diverse group of pathological entities that pose diagnostic challenges, particularly in adults where malignant causes must be excluded. Branchial cleft cysts are congenital anomalies that often remain asymptomatic until adulthood, presenting after secondary infection or abscess formation. We report a case of a complicated second branchial cleft cyst in a 38-year-old male presenting with recurrent laterocervical abscess. Diagnosis was established through clinical evaluation, imaging, and histopathological analysis. Initial management involved abscess drainage and exclusion of malignancy, followed by definitive surgical excision after infection resolution. The patient recovered fully without recurrence. This case underscores the importance of a systematic diagnostic approach and timely surgical management to prevent recurrence and complications in adult patients with cystic neck lesions.

Second branchial sinus anomalies are rare congenital paediatric maladies that arise during intrauterine embryogenesis. A unique case of second branchial arch sinus in a 5-month-old infant, where a minimally invasive transcervical endoscopic intervention was undertaken, is being reported. The presentation was with recurrent discharge from a punctum at the lower lateral aspect of the neck. Global literature on second branchial arch anomalies is reviewed with clinical presentation, imaging, diagnosis, and therapeutic modalities of this rare entity.

IntroductionEctopic thyroid gland is a rare condition, could be associated with hypo or hyperthyroidism, with or without normally positioned thyroid tissue and occurs due to embryogenic defect. Here we present a 44 years old female with submental mass proved by biopsy to be thyroid tissue.Thyroid ectopia (TE) means presence of thyroid tissue at position other than its normal site (below the larynx and anterior to 2nd-4th tracheal cartilages) due to genetic defects during embryonic journey of thyroid gland (TG), firstly described in 1869 at basis of the tongue(1). Prevalence of ectopic thyroid gland ( ETG) is 1 per 100,000-300,000, more in females, could present with eutopic TG and the lingual ETG is the most common site, but could occur everywhere in the body and even sometimes could occur in 2 or 3 different sites at the same time(1).Clinical CaseA 44 years old female patient presented with a 15 years history of painless, slowly growing submental lump, no dysphagia, dyspnea, fever or history of trauma. There was non-tender, mobile, 4 cm x 2 cm smooth surface submental swelling. She has mildly elevated TSH 5.05 mIU/L (0.2 – 4.2 mIU/L) and normal Free T4. Neck ultrasound (US) revealed no TG at its normal position, submental right sided small rudimentary thyroid – like soft tissue lesion (ETG) with large lobulated margin, 4cm x 2cm x 3cm solid isoechoic nodule. FNAC was not conclusive, true cut biopsy showed multiple thyroid follicles of variable sizes with colloid.Patients with ETG may be asymptomatic or have dyspnea, dysphagia and about 70% percent of patients have hypothyroidism (HT) due to impairment of the supplying vessels (2). Ectopic TG also liable to develop thyroiditis, benign nodules and even malignancy (3). Incidence of malignancy in ETG is 1% and most commonly be follicular. (4). In about 70-90% of cases no normally positioned thyroid tissue, hypothyroidism is common but hyperthyroidism is very rare (5). Branchial cyst, thyroglossal or epidermoid cyst, lymph node, lipoma and malignancy should be kept in mind as other diagnoses in any submental mass (5). If there was suspicion about diagnosis or malignancy is suspected, FNAC is indicated with about 95%–97% accuracy (5).Neck US is useful to detect ETG and examine the normal site of TG, other imaging modalities like CT or MRI also can be used, but still the technetium-99 scintigraphy is the main test to detect site, shape, extension and activity of both ectopic and orthotopic TG(5). Follow up only is needed if the patient is asymptomatic, hypothyroidism should be treated and surgical intervention is indicated for those patients with symptoms like dyspnea, dysphagia or bleeding(5).ConclusionEctopic TG must be considered during assessment of any neck swelling, so neck US, TFT and FNAC (if indicated) should be done to evaluate the mass and examine for orthotopic TG to avoid superfluous surgery which makes the patient in permanent hypothyroidism.Figure 1:Figure shows patient photo, US finding & biopsy finding. Table 1:Summary of the case

IntroductionBranchial cleft cysts (BCC) are congenital cystic lesions of the lateral neck resulting from incomplete obliteration of the branchial clefts during embryogenesis. They are typically located anterior to the sternocleidomastoid muscle and are benign in nature. Papillary thyroid carcinoma (PTC) is the most common histological subtype of thyroid malignancies. Due to its propensity for cervical lymph node metastasis, it may mimic cystic lesions of the lateral neck, posing a diagnostic challenge in adults.Clinical CaseA 35-year-old female presented to the otolaryngology clinic with a painless neck swelling. Physical examination revealed a 3cm lesion in the right level IV region. There was no history of autoimmune thyroid disease, radiotherapy, or family history of thyroid cancer. Ultrasonography showed a normal sized thyroid with a 10×8 mm isohyperechoic nodule in the left lobe, with a regular margin, halo, and peripheral vascularization. In addition, a 30×15 mm anechoic cystic lesion was detected anterior to the sternocleidomastoid muscle and was initially considered as BCC. Fine-needle aspiration biopsy was nondiagnostic. Contrast-enhanced MRI revealed a 17×22 mm well-circumscribed, dense-content lesion, again suggestive of BCC. The patient underwent surgery with this presumptive diagnosis. Histopathological examination demonstrated papillary thyroid carcinoma invasion in the cyst wall, consistent with metastatic PTC. Following multidisciplinary tumor board evaluation, total thyroidectomy with bilateral central and right lateral neck dissection was performed. Postoperative pathology revealed a 0.8 cm oncocytic variant papillary microcarcinoma in the right lobe, with capsular invasion within 0.1 cm, and metastasis in three central lymph nodes. The patient was classified as high-risk and received 150 mCi of radioactive iodine (RAI). Post-therapy I-131 scintigraphy showed uptake confined to the thyroid bed, with no evidence of distant metastasis. During follow-up, TSH was suppressed below 0.1 mIU/L. Stimulated thyroglobulin was 7 µg/L with negative anti-Tg antibodies. At the latest follow-up, thyroglobulin was 0.6 µg/L, consistent with a biochemical indeterminate response.Cystic lymph node metastases of PTC can easily be misdiagnosed as BCC, especially in adults. Several cases in the literature have reported lesions initially excised under the presumptive diagnosis of BCC that were later confirmed as metastatic PTC. Therefore, in adult patients with lateral cervical cystic lesions, careful evaluation is essential, and suspicious radiologic findings must be followed by thorough histopathological analysis. Clinical history, imaging features, and, when necessary, repeat biopsies are crucial for accurate diagnosis.ConclusionPapillary thyroid carcinoma can present as cystic lymph node metastases mimicking branchial cleft cysts; thus, this diagnosis must be considered in adults with lateral neck masses

To analyze the clinical and imaging characteristics of gastric-type endocervical adenocarcinoma (GEA) with the aim of enhancing sonographers' awareness and early diagnostic proficiency regarding this disease. A retrospective analysis was conducted on 9 patients with pathologically confirmed GEA treated at our institution between 2021 and 2024. The study involved a systematic evaluation of clinical manifestations along with transvaginal ultrasonography and magnetic resonance imaging (MRI) characteristics, aiming to analyze the relationship between clinical features and imaging findings in this disease. Clinical characteristics: Nine patients were included. The patients' ages ranged from 28 to 52 years (mean 45.7 ± 8.5). Chief complaints were isolated watery vaginal discharge (4 cases), watery discharge with pelvic pain (1 case), watery discharge with post-coital bleeding (2 cases), and lower-abdominal pain alone (2 cases). HPV screening results were negative in 8 cases, with 1 case positive for HPV type 56. Thin-prep cytology test (TCT) results were negative in 7 cases; 1 case showed atypical glandular cells (suspected cervical origin), and 1 case indicated a few high-grade squamous intraepithelial lesions (HSIL). Gynecological examination revealed cervical hypertrophy with erosion (5 cases), hypertrophy with induration (2 cases), a smooth cervix with mild erosion (1 case), and a normal-size, smooth cervix (1 case). Colposcopy and cervical biopsy indicated: adenocarcinoma (3 cases), suspicious abnormalities (2 cases), CIN I (2 cases), and chronic cervicitis (2 cases). Pre-operative tumor markers: isolated elevation of CA 19-9 (2 cases), concomitant elevation of CA 19-9 and CA 125 (4 cases), and normal values for both markers (3 cases). The duration from symptom onset to diagnosis was ≥1 year in 5 cases. All patients underwent preoperative transvaginal ultrasound examination. The findings were as follows: abnormal cervical echogenicity (3 cases), cervical cancer involving the parametrium (2 cases), a cervical polyp (1 case), a cervical cyst (1 case), and no abnormality was detected in 1 case. Eight patients subsequently underwent pelvic MRI. Among these, 5 examinations were reported as malignant cervical neoplasm, 1 as endometrial carcinoma, 1 as suspicious thickening of the endocervical mucosa, and no appreciable mass was found in 1 case. GEA is characterized by an occult location, low rate of early detection, aggressive behavior, and poor prognosis. Nevertheless, its clinical presentation and imaging findings remain recognizable. In patients who present with persistent, profuse, watery vaginal discharge, careful evaluation of the upper and middle segments of the endocervical canal during gynecological examination and transvaginal ultrasonography is essential to improve early detection and minimize diagnostic omission.

Background Deep neck space abscesses (DNSA) are rare but can be life-threatening due to their rapid progression and variable presentation. Effective management requires prompt diagnosis, appropriate antimicrobial therapy, and timely surgical intervention. Objective To explore the clinical and microbiological characteristics of DNSA and their impact on treatment decisions. Methods This retrospective study analyzed 108 patients with DNSA treated at Eye & ENT Hospital, Fudan University from April 2013 to May 2021. Patient demographics, medical history, clinical symptoms, white blood cell count, imaging results, antibiotic use, and microbiological findings were collected. All patients underwent contrast-enhanced CT, and bacterial cultures guided antibiotic therapy. Results Recurrence of DNSA was strongly associated with undiagnosed branchial cleft fistulas, highlighting the need for thorough etiological evaluation. Larger abscesses were more likely to have detectable pathogens. Streptococcus was the most common pathogen; however, there was no significant correlation between abscess size and Streptococcus infection, suggesting that its pathogenic potential is similar to that of other bacteria. Conclusion and Significance This study emphasizes the importance of timely surgical drainage, individualized antimicrobial therapy, and etiological investigation, particularly for branchial cleft fistulas, in managing DNSA.

Introduction: Fetal oropharyngeal teratoma, or epignathus, is an extremely rare congenital malformation that represents less than 2% of congenital teratomas. Its main clinical relevance lies in the risk of complete obstruction of the fetal airway and perinatal death. Reported cases are typically diagnosed in the third trimester or at birth; however, ultrasound detection in the second trimester remains exceptional. This case provides evidence of early prenatal diagnosis of an epignathus with intrauterine demise in a resource-limited setting. Case presentation: A 20-year-old primigravida with prenatal care beginning at nine weeks presented at 27.2 weeks with rapid abdominal enlargement and a sensation of abdominal tension. Structural ultrasound revealed a heterogeneous oropharyngeal mass measuring 7.5 × 5.7 cm, associated with severe polyhydramnios, pleural effusion, ascites, and nonimmune fetal hydrops. No fetal heart rate was detected. Differential diagnoses included lymphangioma, branchial cleft cyst, rhabdomyosarcoma, and anterior encephalocele, with a presumptive diagnosis of oropharyngeal teratoma (epignathus). Labor induction was performed using 25 µg of vaginal misoprostol every 4 hours, resulting in the delivery of a female fetus weighing 700 g with a 6 × 6 cm oropharyngeal mass causing complete airway obstruction. The mother had a favorable postoperative course without complications. Conclusion: Early prenatal diagnosis of oropharyngeal teratoma is essential for planning care in specialized centers capable of advanced perinatal management. This case is unique due to its second-trimester diagnosis and comprehensive ultrasonographic correlation, contributing valuable information to the existing medical literature. The key takeaway is that timely sonographic suspicion, even in resource-limited settings, allows for diagnostic orientation, genetic counseling, and the provision of comprehensive and compassionate care in the setting of adverse fetal outcomes.

Branchial cleft cysts are congenital lateral neck masses which manifest in the adolescents or in adulthood. They arise from the remnants of the branchial apparatus of embryonic life. Cystic remnants present commonly in the adolescence. Second branchial cleft cysts are the most common form of the branchial anomalies and originate from the remnants of the cervical sinus of His and its duct during the differentiation of branchial apparatus. Purpose of the study was to report a case of second branchial cleft cyst in adolescent. Patient was presented with second branchial cleft cyst at the age of 20 years. Computed tomography of neck showed well-circumscribed cystic lesion with an internal solid component in the peri vertebral space extending to the left submandibular space at the level of lower cervical region, attached to left sternocleidomastoid muscle causing minimal displacement of left internal and external carotid arteries medially and left internal jugular vein laterally, suggesting branchial cleft cyst. Complete surgical excision of the cyst had been done. The histopathologic study revealed a squamous epithelium-lined cyst with lymphoid infiltration, consistent with branchial cleft cyst. The patient was discharged without any complications. Clinical manifestations combined with knowledge of the embryology and spatial anatomy of the head and neck provide clues for a correct diagnosis and appropriate management of branchial cleft cyst.

Cervical schwannomas are rare benign tumors that can present a significant diagnostic challenge, particularly when they exhibit cystic changes that mimic more common lesions such as second-branchial cleft cysts. We report the case of a 36-year-old male who presented with a gradually enlarging, firm, nontender neck mass. Imaging studies, including ultrasound and contrast-enhanced computed tomography, suggested a cystic lesion, most likely a second branchial cleft cyst. Fine-needle aspiration cytology was inconclusive. Surgical excision was undertaken, and histopathological examination revealed a schwannoma with areas of cystic degeneration. Immunohistochemistry demonstrated strong diffuse positivity for S100 protein, confirming the diagnosis. Postoperatively, the patient had an uneventful recovery without neurological deficits. This case highlights the importance of considering cervical schwannoma in the differential diagnosis of cystic neck masses and underscores the essential role of histopathology and immunohistochemistry in establishing an accurate diagnosis. Early recognition and complete surgical excision are key to achieving favorable outcomes.

Background: Branchial cleft cysts (BCCs) are congenital epithelial cysts resulting from developmental anomalies of the branchial apparatus. Type IV BCCs are extremely rare, especially in children. Case Presentation: We report the case of an 11-year-old male presenting with a right-sided neck swelling for 1.5 years and foreign body sensation in the throat for 1 year. Clinical and radiological evaluation confirmed a large Type IV branchial cleft cyst causing significant airway compression. The cyst was excised via a transcervical approach following elective tracheostomy. Postoperative recovery was uneventful, and histopathology confirmed the diagnosis. Conclusion: Type IV branchial cleft cysts are rare in the pediatric population. Accurate diagnosis through imaging and meticulous surgical excision are essential for optimal outcomes and prevention of recurrence.

Branchial cleft cyst, also known as a benign lymphoepithelial cyst, is a congenital disorder with an unclear pathogenesis. It most commonly occurs in the anterior triangle of the neck along the upper third of the sternocleidomastoid muscle, while occurrences at other sites are exceedingly rare. Diagnosis through ultrasound, computed tomography, or magnetic resonance imaging is challenging. Endoscopic submucosal dissection (ESD) enables the acquisition of complete specimens, aiding in the diagnosis and treatment of such lesions. This study presents a case of an esophageal branchial cleft cyst that was successfully diagnosed and treated with ESD, resulting in an excellent postoperative outcome. This case enhances clinical recognition of this rare entity and demonstrates the therapeutic utility of ESD in its management.

A female in her late 40s presented with progressively worsening headaches, nausea, vomiting and gait imbalance and was ultimately found to have a fourth ventricular mass and cervical cyst. Initially presumed to be a neoplastic process, histopathology revealed longstanding neurocysticercosis and reactive changes. The patient underwent suboccipital craniotomy, C1 laminectomy and external ventricular drain placement. Postoperative complications included persistent very low-pressure hydrocephalus (VLPH), venous sinus thrombosis and fluctuating mental status requiring prolonged active cerebrospinal fluid drainage and ventriculoperitoneal shunt placement. This case highlights the diagnostic and management challenges of chronic neurocysticercosis in a posterior fossa location, complicated by rare, VLPH.

Bilateral branchial cleft fistulas are extremely rare congenital anomalies that may be part of a larger syndromic association. Prompt recognition and treatment are crucial in syndromic patients to halt disease progression, improve outcomes, and reduce the risk of long-term complications. Complete surgical excision is the standard treatment for fistulas.

Chronic Non-Infected Branchial Cleft Cyst With Jugular Vein Displacement: Diagnostic and Surgical Challenges in a Rare Neck Mass

We hereby present a case of a 22-year-old female patient with a lesion on the right side of the uvula. Histopathological assessment identified a cystic lesion with a branching configuration. The cyst lining consisted of non-keratinising stratified squamous epithelium, ciliated columnar epithelium, and focal areas of mucinous columnar epithelium. Within the cystic lumen, a focus of ectopic parathyroid tissue was observed. Based on these findings, a final diagnosis of a uvular branchial cleft cyst containing ectopic parathyroid tissue was established. Pathological lesions of the uvula are rare, and cystic lesions typically correspond to epidermoid cysts. This case, therefore, represents the first documented occurrence of a uvular branchial cleft cyst containing ectopic parathyroid tissue, underscoring the importance of detailed histopathological and immunohistochemical evaluation in the assessment of even small, incidentally detected uvular lesions.

Remote access approaches to the neck have gained attention due to cosmetic concerns with conventional cervical incisions. Their safety, reproducibility, and oncologic outcomes remain to be fully validated. We retrospectively analyzed our initial experience with retroauricular robotic neck surgery using the Da Vinci system. Thirty-two patients were included. Data collected comprised demographics, procedure type, surgical features, and oncological follow-up. Thirty-five surgeries were performed: 13 posterolateral neck dissections (levels II-V) with central (VI), 5 modified radical dissections (I-V), 5 posterolateral dissections (II-V), and 1 super-selective neck dissection (I). Twelve neck dissections were combined with thyroidectomy. Additional procedures included 4 partial thyroidectomies, 3 submandibular gland resections, 3 schwannoma resections, and 1 branchial cyst excision, totaling 60 procedures. Twenty patients had malignant disease (62.5%). Median hospital stay was 2days (range 1 9), similar to conventional approaches. Complications included 5 temporary nerve palsies, 1 lymphatic fistula, 1 transient hypoparathyroidism, and 1 minor flap necrosis, all managed conservatively; 1 hematoma required reoperation. Conversion to a conventional approach occured in 4 cases (6.7%). No additional intraoperative or postoperative complications were observed. The mean lymph node yield was 54 in posterolateral/radical dissections and 13 in central dissections. Median follow-up of malignant cases was 41.3months (range 18-56), with a 3-year regional control rate of 94.7%. Our experience with 60 retroauricular robotic procedures demonstrates this approach to be safe, feasible, and oncologically effective, with complication rates, hospital stay, and oncological outcomes comparable to conventional surgery.

Rationale:Bronchogenic cysts (BCs) are congenital anomalies typically located in the mediastinum or lung, with ectopic presentations in the neck being exceptionally rare. The potential for compressive symptoms and malignant transformation underscores the need for precise surgical resection.Patient concerns:A 53-year-old female presented with a self-palpable cervical mass and notable dysphagia. Medical imaging revealed a well-defined cystic lesion in the anterior cervical region.Diagnoses:The histopathological analysis post-resection confirmed a bronchogenic cyst lined by ciliated columnar epithelium consistent with ectopic foregut development.Interventions:Intraoperative neuromonitoring (IONM) was used to assist the complete resection of the cyst through the transcervical approach.Outcomes:The cyst was completely excised with preservation of vocal cord function intact. Postoperative follow-up over 12 months revealed no symptomatic recurrence, and imaging studies demonstrated no evidence of residual or recurrent lesions.Lessons:This clinical case highlights the criticality of considering BCs in cervical midline masses and demonstrates the efficacy of Magnetic resonance imaging (MRI) in differentiating ectopic BCs from adjacent tissues. Complete surgical resection combined with IONM optimized surgical safety, particularly in anatomically challenging regions near the recurrent laryngeal nerve (RLN).