Branchial Cyst Research Articles

Doxycycline sclerotherapy of cervical spine aneurysmal bone cysts: single-institution 13-year experience

BackgroundAneurysmal bone cysts (ABCs) are benign, locally aggressive neoplasms that typically affect patients during their first two decades of life. Curettage with or without bone grafting or adjuvants is the current standard treatment; however, other surgical and medical treatments, such as sclerotherapy, have been reported. Treatment options for cervical spine ABCs are more limited because the proximity of ABCs to critical structures leads to greater risk of spontaneous or treatment-related adverse events, including death.ObjectiveTo retrospectively review all children and young adults with cervical spine ABCs treated with doxycycline sclerotherapy at one referral center to assess its viability as a standalone treatment.Materials and methodsWe retrospectively reviewed the clinical notes and imaging of 16 patients treated with doxycycline sclerotherapy for pathologically proven cervical spine ABCs at our institution between May 2008 and March 2021. All patients underwent image-guided percutaneous doxycycline sclerotherapy to ablate the ABC and stimulate bone formation. We assessed clinical outcomes through chart review and described post-treatment imaging outcomes using modified Neer scoring.ResultsOf the 16 total children and young adults treated, 2 were lost to follow-up, leaving 14 patients with a median age of 14.5 years. Twelve of these 14 patients were successfully treated with doxycycline sclerotherapy for a success rate of 86%. One patient experienced one treatment-related complication (Society of Interventional Radiology [SIR] adverse event classification D), before ultimately being successfully treated. Doxycycline treatment failed in two patients, who then underwent surgical management. Post-treatment imaging of successfully treated cases had a mean modified Neer score of 1.3, whereas post-treatment imaging in failed cases had a mean score of 3.5.ConclusionDoxycycline sclerotherapy is a viable standalone treatment for cervical spine ABCs because it is safe and effective while avoiding the morbidity associated with open surgical treatments.

Facet cysts in the subaxial cervical spine: Case series focused on radiological and histopathological findings with a scoping review

BackgroundFacet cysts in the subaxial cervical spine are a relatively rare cause of neuropathy. This case series aimed to investigate the radiological and histopathological features and surgical results of these lesions, and provide possible mechanisms of cyst development. MethodsThirteen subaxial cervical facet cysts in 12 patients were diagnosed on the basis of magnetic resonance imaging and computed tomography with facet arthrography. Surgical outcomes were evaluated according to the Japanese Orthopaedic Association scores for cervical myelopathy, or Tanaka's scores for cervical radiculopathy. These results were presented in combination with a scoping review of the literature. ResultsSeven cysts were found in the posteromedial region, and six in the posterolateral portion of the spinal canal. Computed tomography revealed degeneration of all involved facet joints. All patients underwent decompression, and the mean recovery rates of Japanese Orthopaedic Association scores and Tanaka's scores were 57.1% and 87.5%, respectively. Histopathologically, all cysts were continuous with the degenerated ligamentum flavum. In the scoping review, the patients' mean age was 65.1 years. The cysts were distributed as follows: 3.6% at C2–3, 10.7% at C3–4, 14.3% at C4–5, 5.4% at C5–6, 7.1% at C6–7, and 58.9% at C7–T1. The presenting symptoms were myelopathy (49.4%) and radiculopathy (50.0%). Radiologically, 55% and 45% of the cysts were of the posteromedial and posterolateral types. Of the patients, 76.9% underwent decompression only, and 23.1% had concomitant fusion. Cyst recurrence was not observed in the mean follow-up period of 15.1 months. ConclusionsThe pathogenesis of cysts is closely related to degenerative changes in the facet joint and ligamentum flavum, and rupture in degenerated ligaments can develop into a cavity, which contributes to cyst formation. The scoping review suggests that cyst resection generally results in positive outcomes without recurrence in either decompression alone or concomitant fusion.

A Retrospective Clinico-Pathological Analysis with Review of Literature of Oral and Cervical Lympho-Epithelial Cysts from a Pathological Perspective

Oral and cervical lympho-epthelial cysts (LECs) are uncommon lesions with histopathological similarities. The aim of the study is to present clinico-pathological characteristics of oral and cervical LECs with a review of literature in order to create awareness on this uncommon entity. Eighteen new cases of oral and cervical LECs obtained from the archives of the University of Peradeniya and University of Geneva were used for the clinico-pathological analysis. The average age at diagnosis of 7 oral and 11 cervical LECs were 40 and 36 years, respectively. Both showed a female predilection (male:female ratio at 3:4 and 4:7, respectively). The only difference was found in the size of the lesions with oral LECs being significantly smaller than cervical LECs (0.9 cm vs. 4.6 cm). LECs may clinically resemble neoplasms (4/18), including malignancies (1/11 in the present series). None of the 18 LECs recurred following surgical removal. The literature-review-based analysis of 514 oral LECs confirms that the lesions are observed predominantly in adults in 4th–5th decades of life and are relatively small lesions of less than 2 cm in diameter. Oral LECs were found to occur predominantly in the tongue and floor of the mouth, similar to 88% of lesions in literature. In conclusion, oral and cervical LECs are two histologically similar cysts that occur in two distinct sites. The literature review supports the information observed in our study with respect to age of occurrence, site predilections, and size. Cervical LECs, particularly the ones that occur in the parotid region, may require further investigations to exclude BLEL of parotid gland, which occur in HIV infected patients.

Six senses while considering hydatid cyst as a differential for a swelling at nape of the neck: a case report

While cervical swellings usually are located in anterior midline like thyroglossal cyst, thyroid swellings or in antero-lateral aspect of neck like cold abscess, branchial cyst, lymphangioma, cervical lymphadenopathy. Nape of the neck swelling is even less common with differentials including lipoma, sebaceous cyst, lymphangioma. Hydatid cyst (HC) is often missed as a differential resulting in intraoperative surprises. This case report might change the mind of the readers to keep HC in back of their minds while approaching a case of swelling of the neck. Here we reported a case of 15 years female who presented with swelling of nape of neck which on evaluation was inclining towards lipoma/epidermal cyst. With an intention for surgical exploration and excision patient was taken for operation, where we discovered it to be HC which was later confirmed by histopathology as well. Because of its rare presentation the primary diagnosis of HC was often missed out in spite of having sensitive cytology and imaging modalities. Hence, by reporting this case we intend to emphasize six facts a clinician, a radiologist and also a pathologist must consider while keeping primary HC at an unusual site as a differential diagnosis.

Ventral Cervical Intradural Extramedullary Neuroenteric Cyst and its Operative Procedure; A Rare Case Report with Literature Review

Background:Neuroenteric cysts are rare non-neoplastic lesions arising from a failure of dissolution of the transient neuroenteric canal between the foregut and the notochord. They are most frequently seen in the intraduralextramedullary space in the lower cervical and upper thoracic spine. Case description:A 5 yrs old boy presented to us with the complaints of neck and upper back pain and weakness of all four limbs. MRI scan shows an intraduralextramedullary cystic lesion at C6-T1 with significant compression over cord. After patient’s preparation a Posterior approach was used to remove the cysts. Post-operative course was un-eventful. Histological results were consistent with neuroenteric cysts. MRI image of 3 months follow-up shows no residual cysts and the boy has no further complaints. Conclusion:Neuroenteric cyst (NC) is a rare lesion usual location at lower cervical and upper dorsal area and should be considered among differential diagnoses. Complete excision is the treatment of choice. In most instances a dorsal surgical approach will be satisfactory. Bang. J Neurosurgery 2021; 11(1): 54-57

Lateral cystic neck masses in adults: a ten-year series and comparative analysis of diagnostic modalities.

In adults, the solitary lateral cystic neck mass remains a diagnostic challenge with little solid material to target for cytology and few clues on imaging modalities to suggest underlying malignancy. This study was a retrospective review of patients presenting with a lateral cystic neck mass to a tertiary academic head and neck centre over a 10-year period. A total of 25 of 157 cystic lesions were subsequently malignant on paraffin section histopathology, with the youngest patient being 42 years. In the age cohort over 40 years, 30 per cent of males and 10 per cent of females were diagnosed with malignancy. The ipsilateral palatine tonsil was the most common primary site (50 per cent). A total of 85 per cent of cases demonstrated integrated human papillomavirus infection. Age, male sex and alcohol were significant risk factors on univariate analysis. Ultrasound-guided fine needle aspiration cytology and magnetic resonance imaging represented the most accurate pre-open biopsy tests. The authors of this study advocate for a risk-stratified, evidence-based workup in patients with solitary lateral cystic neck mass in order to optimise timely diagnosis.

Intraoral Approach for Parapharyngeal Branchial Cleft Cysts.

Branchial cleft cyst (BCC) most frequently arises from the second branchial cleft and is located anterior to the sternocleidomastoid muscle at the mandibular angle. However, very rarely, this may occur in the parapharyngeal space. Interestingly, the parapharyngeal BCC is frequently misdiagnosed as a peritonsillar abscess. In this study, we reported 2 cases of parapharyngeal BCC misdiagnosed as peritonsillar abscess.

An Unusual Presentation of type-IV Second Branchial Cyst: A Case Report.

Second branchial cleft cysts are a cystic dilatation of the remnant of the second branchial cleft that account for 95-percent of all branchial cleft malformations, along with second branchial fistulae and sinuses. Among them, the type-IV second branchial cyst is present against the pharyngeal wall in the parapharyngeal space and is rarest of all. Herein we report a rare presentation of type-IV second branchial cyst where MRI played a critical role for accurate preoperative diagnosis. The transcervical approach is a safe and effective technique for proper exposure and hence total surgical excision in such cases.

Branhijalna cista vrata - šta je zaista važno? - prikaz slučaja

Introduction: Branchial cleft anomalies are considered to develop from the branchial apparatus that did not completely obliterate during the embryogenesis of the head and neck. These anomalies pose a significant challenge in terms of surgical management, particularly followed by misdiagnosis due to its rarity. The aim of this case report was to present the review of literature and treatment of a rare anomaly such as a second branchial cleft cyst with a particular focus on clinical as well as histopathological aspects. Case report: A 24-year-old woman was admitted to the otolaryngology department with a three-month history of painless right-sided neck swelling, following a previously resolved upper respiratory infection. The patient underwent complete excision of the cystic mass, with excellent cosmetic results and no signs of recurrence after a one-year follow-up. Conclusion: Therefore, surgery should always be the gold standard of treatment. In patients aged over 40 years, cystic metastasis from the occult head and neck primary carcinoma must be considered.

Branchial Cleft Cyst in Unusual Location: Vallecula

Branchial Cleft Cyst in Unusual Location: Vallecula

Rare diseases in practice of otorhinolaryngologist of outpatient clinic. Some aspects of diagnostics

The article is a review of the diagnostic features of some rare ENT diseases, which the author would like to focus on based on his own clinical experience to help the outpatient otorhinolaryngologist. Among such diseases are neuroma of the VIII cranial nerve and tumors of the nasopharynx. It is emphasized that the first symptoms in the form of hearing loss in these diseases can help guide the doctor’s thoughts in the right direction in order to transfer the patient to a specialized institution in a timely manner. The importance of Weber’s test in the diagnosis of these diseases is noted. So, with neuroma of the VIII nerve, the symptom of N. S. Blagoveshchenskaya (lack of lateralization toward the better ear in case of unilateral hearing loss according to the type of sound perception) makes it possible to suspect an acoustic neuroma. And with a tumor of the nasopharynx, a unilateral hearing loss according to the type of sound conduction, resulting from compression of the auditory tube by the tumor, may be the first symptom of the disease. The article discusses the diagnostic aspects of other rare ENT diseases: destructing adenoma of the nasal septum, granulating external otitis, benign tumors of the sweat glands of the auricle and external auditory canal, lateral branchial cysts of the neck. In addition to the listed diseases, the author, also sharing his own clinical observations, dwells on a rather rare complication of latent sphenoiditis – paresis of the abducens (VI) nerve. Another clinical example devoted to anosmia describes a rare mechanism of its development – traumatic, when falling back and hitting the surface with the back of the head. This mechanism can be explained by the detachment of olfactory fibers in the region of the cribriform plate of the ethmoid bone, which occurs due to the inertial displacement of the brain structures during a backward fall.Кеyworlds: neuroma, acoustic, early diagnosis, nasopharyngeal tumor, destructive nasal septum adenoma, granulating otitis externa, benign tumors of the auricle, lateral branchial (congenital) cysts of the neck, latent sinusitis, sphenoiditis, optochiasmal arachnoiditis, abducens (VI) nerve, trauma of the ethmoidal labyrinth, anosmia.

A Case of First Branchial Cleft Fistula with Tympanic Membrane Anomaly

A Case of First Branchial Cleft Fistula with Tympanic Membrane Anomaly

Diagnostic Challenges of Uncommon Paediatric Head and Neck MassesA Case Series

Paediatric head and neck masses pose diagnostic challenge to the clinicians owing to the wide spectrum of lesions including congenital (developmental), inflammatory and neoplastic lesions. In this case series, uncommon paediatric head and neck mass lesions that were diagnosed in a tertiary care hospital over a period of three years from January 2017 to December 2019, had been included, emphasizing on the diagnostic challenges encountered. First case was of Cervical Chondrocutaneous Branchial Remnant (CCBR) that was misdiagnosed as branchial cyst clinically. Second case was a lymphoepithelial cyst that masqueraded as an acute suppurative lymphadenitis in Fine Needle Aspiration Cytology (FNAC) due to florid inflammation. Third case was an aggressive poorly differentiated malignant neoplasm of left nasal cavity namely Nuclear protein in Testis (NUT) carcinoma that had to be differentiated from several other small round blue cell tumors. Fourth was a case of lipoblastoma which could be mistaken for myxoid liposarcoma. The last two cases were vascular tumors, one of them was juvenile capillary hemangioma with a benign clinical course while the other was an intermediate grade tumor namely kaposiform hemangioendothelioma. A wholesome clinical, radiological and pathological evaluation will help to solve the diagnostic dilemmas in this group of lesions.

Infected Branchial Cleft Cyst Due to Neisseria Meningitidis: An Unusual Presentation in a Pediatric Case

Meningococcal disease, which is caused by Neisseria meningitidis (N. meningitidis), may present clinically as meningococcemia, as meningitis, or with a mixed picture. A 3-year-old girl was admitted to our hospital with a tender, immobile, hard, hot and erythematous mass measuring 3x4 cm on the left anterior part of the neck. The patient was diagnosed with branchial cleft cyst in the left side of the neck and regularly followed by an otolaryngologist since 6-month-old. The abscess culture grew N. meningitidis. Serogroup determination identified nongroupable Neisseria meningitidis. Infected branchial cleft cyst associated with N. meningitidis has rarely been reported, and to our knowledge, this is the second case in the literature. This demonstrates the importance of microbiologic identification, which plays a major role in the management of the patient. It should be noted that N.meningitidis can present with unusual clinical manifestations affecting all systems of the body; which indicates the importance of vaccination in vaccine-preventable diseases.

Prevalence of cystic metastases in a consecutive cohort of surgically removed branchial cleft cysts

Background Solitary cystic lesion of the neck may often be the only initial presenting symptom for branchial cleft cysts and cystic metastases. Aims/objectives To analyse the malignancy rate detected in patients undergoing surgical treatment for lateral branchial cleft cyst. Material and methods The records of all patients with surgical procedure code ENB40 (Excision of lateral branchial cleft cyst- or fistula) between 2003 and 2019 were reviewed. After excluding 150 patients, 436 patients were included for final analysis. Re-evaluation of the cytology including HPV-analysis was performed in those who had a malignant cyst. Results Cystic metastases were demonstrated histologically after surgical excision in 13 patients (3%). In patients over 18 years of age, the prevalence of cystic metastasis regardless of the primary tumour type was 3.3%. Conclusion and significance When the investigation protocol for solitary cystic lesions of the neck is followed, the negative predictive value for malignancy is 97%. All adult patients with a cytologic verified diagnosis of branchial cyst should be examined with HPV-analysis of the cystic sample before excision of the cyst. Failure of predicting a malignancy is often associated with cytology of poor cellularity which may be improved by more frequent use of ultrasound guided fine-needle aspiration cytology (FNAC).

Mini-incision with endoscope-assisted surgery for bilateral congenital second branchial cleft fistula and a pedigree report

Objective: To investigate the feasibility and efficacy of mini-incision with endoscope-assisted resection for bilateral congenital second branchial cleft fistula, and to report on a rare pedigree. Methods: The clinical data of 5 patients with bilateral congenital second branchial fistula admitted in Fujian Provincial Hospital from April 2007 to December 2018 were retrospectively reviewed, including 2 males and 3 females, aged from 3 to 31 years old. The surgical strateges and clinical experience of single mini-incision with endoscope-assisted fistulectomy were summarized, and a rare pedigree was reported. Results: In five patients, Case 1 to Case 4 were treated with bilateral endoscopic-assisted fistula high ligation with titanium clips and removal through a single small incision under general anesthesia. No obvious complications occurred after the operation. The patients were followed up for 40-164 months with no fistula recurrence. Case 5 gave up surgical resection and was followed up for 24 months with acute infection attack once. Case 2 and Case 4 came from the same family. In this family, 7 out of 31 members of four generations had second branchial cleft fistulas, of which 4 were bilateral and 3 were right. Pedigree analysis was consistent with autosomal dominant inheritance. No deafness, preauricular tag, external and middle ear deformity and kidney malformation were found in the family members. Conclusions: Bilateral congenital second branchial cleft fistula is rare. Surgical resection is the preferred treatment. Mini-incision with endoscopic-assisted fistula high ligation with titanium clip and resection has clear operative field, ideal cosmetic effect and definite curative effect.

Spontaneous regression of large fetal antero-lateral neck cysts: A case report and literature review

The entity of fetal lateral cervical cysts is presented as an isolated anomaly or associated with other sonographic structural findings, sometimes being determined by chromosomal abnormalities. We report a case of spontaneous regression of large fetal anterolateral cervical bilateral cysts diagnosed by ultrasonography at 13 weeks. Complete resolution of cervical cysts was documented at 20 weeks. The patient reveals no concerning results to other assessments related to her pregnancy including first trimester bio-chemical screening, cell free fetal DNA testing, routine laboratory tests, ultrasound repeated evaluation of fetal growth and wellbeing. When fetal anterolateral cervical cysts are encountered as isolated finding, completely separated by nuchal translucency fluid collection, regardless of the cystic diameter and bilaterally, the rules are normal karyotype, high rate of total regression and preservation the good pregnancy outcome.

Branchial Sinus with Cyst - Two Case Reports with Review of Literature

Branchial cleft anomalies are well described, with the second arch anomaly being the commonest. Remains of cervical sinus of His may persist as a branchial cyst. A branchial sinus is formed when 2nd branchial arch fails to meet the 5th pharyngeal arch. Peak age for presentation of branchial cysts is in the third decade and that of the congenital sinuses and fistulae is at birth. The association of a branchial cyst with branchial sinus is very rare. We are presenting two cases had branchial cyst along with branchial sinus. It was managed successfully with complete excision. Histopathological examination confirmed the association. Keywords: Branchial Sinus, Branchial cyst,

A rare case of co-existing branchial cyst and thyroglossal cyst

<p class="abstract">Thyroglossal duct remnants and branchial arch anomalies are the most common congenital neck masses. These anomalies typically present in childhood or early adulthood as cysts, sinuses or cartilaginous remnants, but may rarely present in late adulthood. Although both thyroglossal duct remnants and branchial cysts may be encountered individually, these anomalies are rarely encountered together in the same individual. We report the third such case of co-existing branchial cyst and thyroglossal cyst occurring in the same individual with review of embryological development of thyroglossal duct cysts and second branchial arch anomalies.</p>

Head and Neck Swelling: A Cytopathological Perspective in a Hospital Based Study.

Introduction: Fine Needle Aspiration Cytology is a simple, relatively less painful, cost-effective minimal invasive procedure commonly employed in the evaluation of head and neck swellings. There are limited studies on cytological findings of head and neck swelling in Nepal. Objectives: The objective of this study was to study cytological findings of head and neck swellings. This study further intends to classify the nature of the swelling and use standardized international reporting system wherever required. Methodology: This is a retrospective hospital-based study done in the Department of Pathology at the Helping Hands Community Hospital, Kathmandu between 1 January 2019 and 32 December 2019. Slides of all FNAC from head and neck swelling done during this period was retrieved and evaluated for the study. Chi-Squared (χ2) test was used to investigate the significance of epidemiological and cytological parameters. Results: Males (56%) had more head and neck swelling than females (44%). The younger age group of less than twenty-five (< 25) years had more frequency of head and swelling followed by the older age group of more than fifty (>50) years. The most common site for Fine needle aspiration was lymph nodes (58%) followed by thyroid swelling (23%). Salivary gland swellings were the least frequent (5%). Of all the swelling, 17% of cases were attributed to malignant causes. Infective/Inflammatory causes (55%) were the most common cause of lymph node swellings. Metastatic carcinoma was more prevalent in the older age group of more than fifty (>50) years with a prevalence of 21% of total cases studies. Most of the thyroid swellings were found to be benign (58%) whereas 16% of thyroid swellings belonged to the malignant category. The total numbers of salivary gland swelling were the least with 55% of cases having benign neoplastic etiology. Diagnosis of developmental anomalies like a thyroglossal cyst, lymphangioma, branchial cyst, though relatively less common (10%) were also made with the help of cytologic studies. Conclusion: Fine Needle Aspiration is a useful method to differentiate benign and infective cases of head and neck swelling from neoplastic cases.