Branchial Cyst Research Articles

Bilateral Vertebral Artery Fenestration in a Case of Craniovertebral Junction Neurenteric Cyst: Implications for Surgical Planning

Abstract Vertebral artery fenestration (VAF) is a type of anomaly of the vertebral artery in which a segment of the vessel divides into two separate channels that join together later in the course. Neurenteric cysts are rare, congenital lesions arising within the spinal canal usually in the cervical region. Vertebral artery anomalies if not considered during operative planning can lead to iatrogenic injury. We report a case of a 5-year-old boy who presented with a history of acute onset, non-traumatic spastic quadriparesis. Examination revealed the presence of cervical neurenteric cyst present ventrally at C1–C3 level. Further workup revealed the presence of bilateral VAF with the fenestrated part going along the inferior aspect of the arch of atlas bilaterally. Surgical excision of the lesion was done taking into consideration the anomalous course of vertebral artery. VAFs are classified according to their location as intracranial or extracranial and according to the segment of the vertebral artery from which they arise (V1–V4). Iatrogenic injury to the vertebral artery has been reported during both anterior and posterior approaches to the cervical spine. Due consideration should be given to anomalous course of vertebral artery while planning the surgical approach in craniovertebral junction.

Surgical outcome and prognostic factors for 39 recurrent spinal hydatid cysts.

Cystic bone echinococcosis accounts for 0.5-4% of all reported cases, and 45% occur in the spine. Our aim was to review the clinical and radiological features, surgery, and outcomes for 39 patients with recurrent spinal hydatidosis. Thirty-nine reports of patients with recurrent spinal hydatidosis (2011-2020) were followed for an average of 9.28 ± 5.60 months. Lesions occurred in descending order in the; lumbar (48.7%), thoracic (43.6%), and cervical spine (7.7%). Total cyst resection was achieved in 28 of 39 patients (71.8%). Intraoperative cyst rupture occurred in 13 patients (33.3%). The postoperative American Spinal Injury Association (ASIA) score was "good" in 82% of patients. Those with "poor" postoperative ASIA scores had a 41% incidence of recurrent thoracic hydatid cysts; further, they demonstrated significantly higher recurrence rates if cysts had ruptured intraoperatively (P = 0.001). In addition, laminectomy, subtotal original cyst resection (P < 0.007), and a thoracic location were all significantly associated with higher recurrence rates (P < 0.04). The majority of patients demonstrated improvement following surgery for cervical hydatid cysts. Notably, those with poor outcomes typically experienced intraoperative ruptures of their thoracic hydatid cysts, contributing to high cyst recurrence rates.

Ultrasound diagnosis and treatment of branchial cleft cyst and preoperative management.

The ultrasonic diagnosis of cervical and facial cystic masses, as well as cases of missed diagnosis and misdiagnosis, was examined, to improve the diagnosis of branchial cleft anomalies. A retrospective analysis was conducted on 17 patients with branchial cleft cyst anomalies, including 11 males and 6 females, aged 12-53years, with an average age of 33 ± 2years, were unilateral single. All patients who underwent an ultrasound examination and image storage for retrospective analysis, and both longitudinal and transverse sections were scanned to observe the shape, size, boundary, peripheral relationship, and blood flow signal of the masses. All cases were examined with an enhanced CT scan, and pathological reports were generated. Among the 17 cases of branchial cleft anomalies, 15 cases were branchial cleft cysts, while one case involved fistula formation and one case involved sinus tract formation. Based on the type of branchial cleft, the first, second, and third cysts were classified in 4, 12, and 1 case, respectively. The sensitivity rate and specificity of ultrasonic diagnosis were 14/17 (82.4%) and 4/6 (66.7%), respectively. Ultrasonic characteristic analysis for the masses can be found in simple cystic masses or hypoechoic masses, most of them are of a regular shape and have a distinct boundary, and almost no blood flow signal. All patients who were misdiagnosed exhibited blood flow signals, including 1 patient with an abundant blood flow signal, 1 patient suspected of having ectopic thyroid with an abnormal function due to the rat-tail sign, 2 patients misdiagnosed as local inflammatory focus, and 1 patient misdiagnosed with tuberculous lymphadenitis. Ultrasound has a detection rate of up to 100% for cervical and facial masses, providing a fundamental determination of lesion characteristics and specific guidance for preoperative diagnosis. If the blood flow signals can be identified and carefully considered their peripheral relationship, the diagnostic rate can be improved.

Venolymphatic malformation – parotid gland

Abstract: Vascular malformations (VMs) are a rare clinical entity and even rarer are those originating from the salivary glands. Those arising from the parotid gland are the most reported with the most common subtype being venous or arteriovenous malformation. Here, we report a case of a neck mass which was identified as a venolymphatic VM in the parotid gland. A 14-year-old patient presented with a progressive right-sided facial mass without constitutional symptoms. Ultrasonography of the mass showed a well-defined lobulated parotid mass with few cystic areas and minimal vascularity, thus deducing a differential of either a branchial cyst or a pleomorphic adenoma. Excision of the mass was performed and sent for histopathological diagnosis. The grossly hemorrhagic and congested specimen showed many vascular channels lined by flat endothelium on microscopy. These dilated channels of varying sizes had many red blood cells and proteinaceous fluid. The lesion was also seen infiltrating the normal surrounding structures of the salivary gland tissue. With the rare incidence of VMs occurring anywhere in the body, diagnosing a venolymphatic malformation occurring in the parotid gland was an out of common experience. Better imaging of a mass in the salivary gland using not only ultrasonography but also color Doppler and magnetic resonance imaging can help rule out the rare entities that can sometimes be overlooked and help plan better treatment for the patient.

A rare case of second branchial fistula with two external openings

Branchial apparatus was first described by Von Baer, but Von Ascheron was the one who described the anomalies in its development. The branchial cyst, sinus and fistula are anomalies of the branchial apparatus which consists of five mesodermal arches separated by invagination of ectoderm (clefts) and endoderm (pouch). Here we present a case of bilobulated second branchial fistula which had both openings over the skin of right anterolateral aspect of the neck. A seven years old girl, presented to ENT OPD, complaining of swelling on right side of the neck associated with discharge from an opening over the swelling since birth. The swelling was painless, progressively increasing in size. Her mother revealed that she had occasionally had a clear discharge from the openings since birth. On examination, dumbbell shaped cystic swelling approx. 5×2 cm in size with two pinhead openings on both the ends, noticed along the anterior border of SCM over the middle third of the neck. Radiological and histopathological investigations confirmed the diagnosis of second branchial fistula. Patient was managed with complete surgical excision. Second branchial anomalies present along the anterior border of sternocleidomastoid. Fistulous tract commonly extends into the pharynx, most commonly in the region of tonsillar fossa. This case report describes a congenital anomaly for which the definitive treatment was surgery. Unlike, other complete second branchial fistula it had two external openings and it was a bilobulated tract, which makes this case a rare variety of branchial fistula

Misdiagnosed Branchio-Oto-Renal syndrome presenting as proteinuria and renal insufficiency with insidious signs since early childhood: a report of three cases

BackgroundBranchio-oto-renal (BOR) syndrome is an inherited multi-systemic disorder. Auricular and branchial signs are highly suggestive of BOR syndrome but often develop insidiously, leading to a remarkable misdiagnosis rate. Unlike severe morphological abnormalities of kidneys, knowledge of glomerular involvement in BOR syndrome were limited.Case presentationThree cases, aged 8 ~ 9 years, visited pediatric nephrology department mainly for proteinuria and renal insufficiency, with 24-h proteinuria of 23.8 ~ 68.9 mg/kg and estimated glomerular filtration rate of 8.9 ~ 36.0 mL/min/1.73m2. Moderate-to-severe albuminuria was detected in case 1, while mixed proteinuria was detected in case 2 and 3. Insidious auricular and branchial fistulas were noticed, all developing since early childhood but being neglected previously. EYA1 variants were confirmed by genetic testing in all cases. Delay in diagnosis was 8 ~ 9 years since extra-renal appearances, and 0 ~ 6 years since renal abnormalities. In case 1, therapy of glucocorticoid and immunosuppressive agents to accompanying immune-complex mediated glomerulonephritis was unsatisfying.ConclusionsBOR syndrome is a rare cause of proteinuria and abnormal kidney function and easily missed, thus requiring more awareness. Careful medical history taking and physical examination are essential to early diagnosis. Massive proteinuria was occasionally seen in BOR syndrome, which might be related to immune complex deposits. A novel pathogenic variant (NM_000503.6 (EYA1): c.1171delT p.Ser391fs*9) was firstly reported.

A 15-year-old Girl with a Lateral Neck Mass Turning Out to Be Papillary Thyroid Carcinoma-Lateral Ectopic Papillary Thyroid Carcinoma or Lymph Node Metastasis?

Lateral neck lesions in children are common and involve various infectious or inflammatory etiologies as well as embryological remnants such as branchial cleft cysts. Although unusual, ectopic thyroid tissue can also present as a lateral neck mass. Here, we present an unusual case of a 15-year-old girl treated for an asymptomatic lateral neck mass that after surgical removal was found to be papillary thyroid carcinoma (PTC). However, after removal of the thyroid gland, no primary thyroid tumor was found. The question arose whether the lateral neck lesion was a lymph node metastasis without identifiable primary tumor (at histological evaluation) or rather malignant degeneration of ectopic thyroid tissue. Total thyroidectomy was performed with postoperative adjuvant radioactive iodine ablation. Even though PTC in a lateral neck mass without a primary thyroid tumor has been described previously, pediatric cases have not been reported. In this report we share our experience on diagnosis, treatment and follow-up, and review the existing literature.

A case of tracheotomy using the Ex Utero Intrapartum Treatment (EXIT) procedure in cooperation with multiple professions.

In this study, we report a case of tracheotomy using the ex utero intrapartum treatment (EXIT) procedure in a fetus that was pointed out as having bilateral giant cervical cysts at prenatal diagnosis and whose postnatal airway occlusion was predicted. The subject was a female aged 35. She was diagnosed with polyhydramnios at 28 weeks of pregnancy. The fetus was found to have a giant cervical cyst before she was referred to the department of obstetrics and gynecology of our hospital. On the second day of 37 weeks of pregnancy, oral tracheal intubation was attempted on the fetus using the EXIT procedure after the caesarean operation, but intubation was difficult resulting in a tracheotomy. The oxygenation of the fetus during the operation was maintained well without any postoperative complication. Postnatal fetal airway occlusion is a critical incident which may lead to the death of a fetus. It was assumed, however, that the airway management under the same procedure was completed by the preoperative detailed simulation with the staff of the departments of anesthesiology, obstetrics and gynecology and pediatrics as well as the operating room personnel.

Clinical Pearls of Branchial Cleft Cyst Management in an Adult

INTRODUCTION: Second branchial cleft anomalies most commonly present as cysts followed by sinuses and fistulae. They have been classified into four different sub-types by Bailey. Type II is most common type where the branchial cleft cyst (BCC) lies anterior to the sternocleidomastoid muscle, posterior to the submandibular gland, adjacent and lateral to the carotid sheath. In this article, a case of type II second branchial cleft anomaly is presented. CASE REPORT: This article aims to portray how to evaluate a patient with second branchial cleft cyst focussing, focusing on how its diagnosed and its appropriate management. A young woman who had chief complaint of swelling of left side of the neck visited our outpatient department. She underwent complete excision of the lesion. There was no recurrence at 1year follow-up visit. DISCUSSION: Most branchial anomalies arise from the second branchial apparatus. Most second BCCs are located in the submandibular space. Patients with BCCs are usually older children or young adults. MR imaging provide the surgeon adequate preoperative information. Treatment for these lesions is complete surgical excision.

Cystic Cervicitis and Infertility, A New Treatment Modality: A Case Report and Review of the Literature

We present a rare case of cystic cervicitis in a 42-year-old woman who came to our unit suffering from primary infertility for one year. Her only complaint was infertility. She was not suffering from chronic pelvic pain or increased vaginal discharge neither before nor after marriage. Diagnosis of cystic cervicitis was made by both transvaginal ultrasound examination and MRI. As her main problem was infertility, she refrained from doing cone biopsy and opted for an ICSI trial and aspiration of the cervical cysts at the same time of ovum pick up (OPU). Ovum pick up resulted in the recovery of two oocytes. On the same setting and using the same needle, aspiration of all of the cervical cysts was performed successfully. Aspirated fluid was sent for cytology as well as culture and sensitivity. To our knowledge, this is the first case, in the english literature, to provide complete diagnosis of, and describe treatment of cystic cervicitis by transvaginal aspiration of the cysts.

Unusual Branchial Cleft Cyst at Parapharyngeal Space: Case Report and a Review of Literature.

Branchial cleft cyst in parapharyngeal space is a very rare occurrence. Only 0.5% of all head and neck tumours constitute parapharyngeal space tumours. It is mainly congenital but can be seen at a later age following infection. MRI is the gold standard for diagnosis. This is a case report of a 19-year-old with right sided neck swelling without any significant history. It has been excised by transcervical approach.

Cervical Thymic Cyst - An Overlooked Entity

Thymic cysts are one of the rare causes of neck masses in the paediatric age group. Patients may complain of neck swelling either central or lateral neck swelling. There is difficulty in diagnosing a cervical thymic cyst as it may mimic a branchial cleft cyst or a cervical lymphangioma. Definitive diagnosis of a thymic cyst requires histopathological examination of thymic tissue. We report a case of a 6-year-old girl who presented with painless lateral neck swelling for 2 months duration. Computed tomography (CT) scan showed a left branchial cyst with retropharyngeal extension. The patient underwent complete excision of the mass and histological examination was reported as a cervical thymic cyst. Postoperatively, she was able to be discharged after serial follow-ups with no signs and symptoms of recurrence.

Type-I Branchial Cleft Fistula, A Rare Incidence: Treated with Surgical Excision

Type-I Branchial Cleft Fistula, A Rare Incidence: Treated with Surgical Excision

MAXILLOFACIAL DIPROSOPUS: AN EXTREMELY RARE CONGENITAL ANOMALY AND ITS SURGICAL MANAGEMENT

Diprosopus characterizes congenital craniofacial duplication, an exclusive maxillofacial involvement that has only been documented twice. A seven-month-old girl attended the surgical outpatient clinic due to a congenital mandibular alteration and cervical tumor mass. Extraoral physical examination revealed a 3cm right sessile appendiceal nodule with a central ostium, which secreted a hyaline fluid in the mandibular cutaneous region and was mobile during breastfeeding. Moreover, an ipsilateral level II asymptomatic cervical enlargement was observed. A computed tomography showed the duplication of the condyle, ramus, and mandibular body on the right side, which had a mandibular canal and teeth germs emerging toward the skin nodule, as well as a 4.1cm submandibular/cervical well-defined cystic hypodense image. Clinicoradiographic aspects were conclusive for mandibular and mouth duplication. Surgical excision of the accessory mandible, cutaneous nodule/accessory mouth, and cervical cyst were performed and sent for pathological examination. The patient is undergoing strict follow-up, without post-surgical complications. Diprosopus characterizes congenital craniofacial duplication, an exclusive maxillofacial involvement that has only been documented twice. A seven-month-old girl attended the surgical outpatient clinic due to a congenital mandibular alteration and cervical tumor mass. Extraoral physical examination revealed a 3cm right sessile appendiceal nodule with a central ostium, which secreted a hyaline fluid in the mandibular cutaneous region and was mobile during breastfeeding. Moreover, an ipsilateral level II asymptomatic cervical enlargement was observed. A computed tomography showed the duplication of the condyle, ramus, and mandibular body on the right side, which had a mandibular canal and teeth germs emerging toward the skin nodule, as well as a 4.1cm submandibular/cervical well-defined cystic hypodense image. Clinicoradiographic aspects were conclusive for mandibular and mouth duplication. Surgical excision of the accessory mandible, cutaneous nodule/accessory mouth, and cervical cyst were performed and sent for pathological examination. The patient is undergoing strict follow-up, without post-surgical complications.

Uncommon Origin of Parotid Swelling

First branchial cleft cyst is a rare disease of the head and neck. A branchial cleft cyst commonly presents as a unilateral solitary, painless soft tissue swelling in the upper region in the neck. It is clinically apparent in late childhood or early adulthood. First branchial cleft cyst accounts for around 8% for all branchial abnormalities. It is possible for first branchial cleft cyst to be easily misdiagnosed as other swellings of the head and neck region. It is imperative that clinicians to make an accurate diagnosis so that appropriate treatment can be offered. A case report of type I first branchial cleft cyst is presented here.

The Outcome of Treatment in Second Branchial Cleft Anomalies: A Case Series.

Background Branchial-cleft anomalies are second only to thyroglossal duct anomalies among congenital malformations of the neck, and second branchial-cleft anomalies are the most common. These include branchial cysts, branchial sinuses, and branchial fistulas. Clinical symptoms include neck swelling and a discharging sinus or fistula opening. In a small number of cases, they can lead to major complications like abscesses or malignant changes. Surgical resection is the treatment of choice. Various approaches to resection and sclerotherapy have been tried. In this study, we present our treatment outcome with branchial cleft anomalies at a ruraltertiary medical care hospital. Objectives To document the various presentations, clinical features, and outcomes of treatment with second branchial cleft anomalies. Methods This retrospective observational study included 16 patients operated on for second branchial-cleft anomalies. A detailed medical history was elicited, and an accurate clinical examination was done. A contrast-enhanced computed tomography (CECT) scan was done in all cases. A few cases required a fistulogram. The cysts, sinuses, or fistulas were resected en bloc by a single neck crease incision. Primary closure was done in all cases. A recurrence or pharyngocutaneous fistula required axial flap reconstruction. The complications and recurrences were documented. Result There were six children and 10 adults in our study. Seven cysts, five sinuses, and four fistulas were present, of which four were iatrogenic. In seven patients, imaging could not show the entire tract. There were four fistulas from the oropharynx to a cutaneous opening in the neck. A complete resection was done for all. Two pharyngocutaneous fistulas were treated with a pectoralis major myocutaneous (PMMC) flap. Three patients had wound dehiscence postoperatively. None of the patients had neurological or vascular injuries. Conclusion Second branchial cleft anomalies can be completely excised by a single neck crease incision. Meticulous surgery results in a low recurrence or complication rate.Following complete excision, in type IVanomalies, a purse-string suture at the pharyngeal opening ensures good closure and no recurrences.

Synovial cysts at the cervicothoracic junction: Illustrative series of three cases.

Spinal synovial cysts are an uncommon pathology, estimated to affect 0.65-2.6% of the population. Cervical spinal synovial cysts are even rarer, accounting for only 2.6% of spinal synovial cysts. They are more commonly found in the lumbar spine. When they occur, they can compress the spinal cord or surrounding nerve roots resulting in neurological symptoms, particularly when they increase in size. Decompression and cyst resection are the most common treatment and typically result in resolution of symptoms. The authors present three cases of spinal synovial cysts occurring at the C7-T1 junction. They occurred in patients aged 47, 56, and 74, respectively, and presented with symptoms of pain and radiculopathy. Diagnosis was made with computed tomography (CT) scan and magnetic resonance imaging (MRI). The cysts were managed with laminectomy, resection, and fusion. All patients reported full resolution of symptoms. There were no intra or postoperative complications. Cervical spinal synovial cysts are an uncommon cause of radiculopathy and pain in the upper extremities. They can be diagnosed through CT scans and MRI, and treatment with laminectomy, resection, and fusion results in excellent outcomes.

A Cervical Thymic Cyst in an Adult Female; A Case Report and Comprehensive Literature Review.

Introduction: Cervical thymic cyst accounts for (0.3-1) % of cervical cysts in children and are usually present during the first decade of life with few reported cases in adults. Herein, we present a 34-year-old female with a cervical thymic cyst. We conducted a review of all the previously reported cases as well. Case presentation: The patient complained of an anterolateral neck swelling that was noticed one year ago. It was a soft, fluctuant, mobile, non-tender swelling in the midline and the right side of the lower neck. Neck ultrasonography revealed a large thin-walled cyst, with no internal septa, echoes, or solid parts. Post-contrast MRI of the neck showed a well-defined, oblong-shaped, lobulated cystic lesion just beneath the strap muscle. The cyst extended caudally to the superior border of the anterior mediastinum at the level of the upper border of the manubrium sterni. The patient underwent excision of the swelling under general anesthesia via Kocher's collar neck incision. Connection with the thymus gland was detected behind the manubrium sterni which was separated. Pathological examination showed prominent thymic tissue confirming the diagnosis of a cervical thymic cyst. Conclusion: Adult cervical thymic cyst is very rare with a few cases reported in the literature. Surgical excision in symptomatic patients is the treatment of choice. Paper's main novel aspects: • A rare presentation of a cervical thymic cyst in an adult. • A comprehensive literature review including all the previously reported cases in one table.

Hemorrhagic cervical juxta-facet cyst presenting with Brown-Séquard syndrome: illustrative case.

Intraspinal juxta-facet cysts of the spine are known to predominate at the lumbar level and is relatively rare at the cervical level. Most cervical spinal lesions are found incidentally, but they sometimes cause myelopathy or radiculopathy in a chronic course. The authors present a rare case of hemorrhagic cervical juxta-facet cyst presenting with Brown-Séquard syndrome. An 86-year-old woman presented with acute-onset right hemiparesis following neck pain and was admitted to the local hospital. She was started on antithrombotic therapy with a suspected diagnosis of cerebral infarction, but quadriplegia progressed 2 days later. Cervical magnetic resonance imaging revealed an intraspinal mass at the C4-5 level and she was referred to the authors' hospital. Her neurological findings on admission revealed right Brown-Séquard syndrome. In emergency surgery, the mass was resected with a posterior approach. Pathological findings showed hemosiderin deposition and fibroblast proliferation, consistent with a juxta-facet cyst with intracystic hemorrhage. The patient recovered well and returned to an independent daily life. Rarely, juxta-facet cyst of the cervical spine can cause acute Brown-Séquard syndrome due to intraspinal hemorrhage. In a case of hemiparesis that develops following neck pain, hemorrhagic cervical juxta-facet cyst should be taken into consideration as a differentiation.

Stratifying risk of malignancy in cystic lateral neck lumps: a multivariant analysis of demographic, radiological and histological investigation factors and the development of a patient-centred risk-predictive tool for malignancy.

Management of lateral cystic neck masses with no apparent upper aerodigestive tract primary tumour in adults is controversial. Imaging modalities and fine needle aspiration cytology often struggle to distinguish the presence of malignancy. This study entailed a multicentre retrospective review of all patients with isolated lateral cystic neck masses from 2012 to 2018 in three Welsh health boards, utilising demographic data and first-line investigations (ultrasound scanning and fine needle aspiration cytology) to develop an evidence-based predictive tool for risk of malignancy. It was found that 29.1 per cent of cystic lesions were malignant on final histology. Age, male gender, non-benign ultrasound scan findings and fine needle aspiration cytology were significant risk factors on univariate analysis. The final multivariate analysis predicted a risk of malignancy ranging from 2.1 to 65.0 per cent depending on the covariate pattern. Smoking status was non-significant. A rigorous, risk-stratified approach to the management of these patients should aid the clinician in minimising morbidity and optimising resources.