Cystic Neck Research Articles

Minimal Invasive Approach to The Branchial Neck Cyst.

Branchial cleft cysts are congenital epithelial cysts, which arise on the lateral part of the neck. They may not present clinically until later in life. Surgical excision is a definitive treatment for branchial cleft cysts. This article presents the clinical report where the big inflamed cysts were excised under local anesthesia. It also presents guidelines for minimally invasive surgery under local anesthesia, which can be used in adequately selected cases.

Diagnostic Accuracy of Circulating Tumor HPV DNA Testing in Patients With a Lateral Neck Mass

The most frequent presenting symptom for patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a lateral neck mass. Circulating tumor tissue-modified viral (TTMV)-HPV DNA is a unique biomarker produced by the fragmentation of HPV DNA during the degradation of HPV-associated tumors, and its detection and quantitation are currently being used as an adjunct to imaging in monitoring for disease recurrence and may have utility for diagnosis. To measure the diagnostic characteristics of TTMV-HPV DNA compared with gold standard tissue biopsy for diagnosing HPV-OPSCC in patients presenting with an indeterminate lateral neck mass. This prospective diagnostic test study enrolled patients 18 years or older who presented with a lateral neck mass to a large urban tertiary health care system from December 2021 to June 2023. Participants underwent standard-of-care testing to obtain a tissue diagnosis and a single TTMV-HPV DNA measurement. The primary outcome of interest was sensitivity, while specificity, positive predictive value, and negative predictive value were secondary end points. A subset analysis was performed comparing test performance metrics between TTMV-HPV DNA testing and fine-needle aspiration. A total of 138 patients were included, of whom 80 (58.0%) were men, with median age of 57.5 years (IQR, 43.3-67.0 years). Of 138 patients, 87 (63.0%) had neck masses in level 2 and 47 (34.1%) had HPV-OPSCC. TTMV-HPV DNA testing exhibited a sensitivity of 95.7% (95% CI, 85.5%-99.5% [45 of 47 patients]), specificity of 97.8% (95% CI, 92.3%-99.7% [89 of 91 patients]), positive predictive value of 95.7% (95% CI, 85.5%-99.5% [45 of 47 patients]), and negative predictive value of 97.8% (95% CI, 92.3%-99.7% [89 of 91 patients]). In this diagnostic study of patients presenting with a lateral neck mass, circulating TTMV-HPV DNA demonstrated excellent diagnostic test characteristics for the detection of HPV-OPSCC. Such testing may have particular utility for patients in whom obtaining adequate tissue is problematic, as is often the case with cystic neck masses and unknown primary tumors.

Clinical analysis of 21 cases of children with ectopic bronchogenic cyst

Objective: To analyze the clinical characteristics, treatment, and prognosis of ectopic bronchogenic cysts in children. Methods: A retrospective analysis was conducted on the data including the clinical characteristics, auxiliary examination and treatment of 21 children with ectopic bronchogenic cysts diagnosed pathologically at Children's Hospital Affiliated to Zhengzhou University from July 2015 to December 2023. There were 16 males and 5 females, with a male-female ratio of 3.2∶1, and the age ranged from 4 days to 8 years old (median age 2 years and 8 months). Results: Among the 21 cases of ectopic bronchogenic cysts, 11 cases were found in the pharynx, with symptoms including dyspnea (4 cases), snoring during sleep (3 cases), and choking on milk(4 cases).Ten cases were found in the head, neck or anterior chest, 5 of these cases had infection history, and 5 showed progressive mass growth.Imaging and endoscopy showed 9 patients underwent preoperative color ultrasonography revealed cystic masses with well-defined boundaries. CT examination was performed on 13 patients, which showed round or nearly round masses with homogeneous density, smooth margins, and regular cyst walls. CT attenuation values ranged from 2 to 52 Hounsfield Units (HU). Four cystic lesions were assessed via MRI, 3 cases demonstrated long T1 and long T2 signals, while 1 case had a slight short T1 and long T2 signal, with high signal intensity on fat-suppressed images. Eleven cases of pharyngopharyngeal cysts were examined by electronic nasopharyngoscopy. The cysts appeared as spherical or ovoid masses with smooth surfaces, close to or slightly light in color with the surrounding tissue, with one cyst presenting with a bluish blue in the oropharynx. All 11 pharyngeal cysts were excised using low-temperature plasma under general anesthesia and intubation assisted by a nasal endoscope. The cysts were pulled and excised as completely as possible.Ten cases of neck and anterior chest cysts were completely excised. Postoperative histopathology confirmed bronchogenic cyst. Twenty-one children were followed up postoperatively for 4 months to 7 years without recurrence, except for 1 patient who was lost to follow-up. Conclusions: Ectopic bronchogenic cysts are uncommon and lack of typical imaging and clinical features.Combination of ultrasonography, CT and MRI is recommended for cases occuered in neck and anterior chest, while electronic nasopharyngoscopy complements pharyngeal evaluations. Surgical intervention is the preferred treatment choice for this disease.

A Rare Case of External Jugular Vein Aneurysm Mimicking Branchial Cyst in a Nigerian Child

Abstract Background: An aneurysm of the external jugular vein is exceptionally rare. Its occurrence in children could present diagnostic challenges due to numerous potential differential diagnoses, including anomalies such as branchial cysts. Objective: This study aims to emphasize the necessity of raising suspicion for jugular venous aneurysms in children with cystic neck masses. Case Summary: We report an 18-month-old boy with a left-sided neck swelling persisting for 10 months. The swelling was cystic and increased in size during straining or crying. A preoperative diagnosis of a branchial cyst was made but was inconsistent with intraoperative findings, where a venous aneurysm was diagnosed. Ligation and excision were performed without sequelae. Conclusion: External jugular venous aneurysms, though rare, should be considered as a potential differential diagnosis in case of lateral neck swellings, especially if they demonstrate compressibility with an increase in size on Valsalva maneuvers. Simple ligation and excision are curative measures.

Efficiency of Fine-Needle Aspiration (FNA) in Relation to Tru-Cut Biopsy of Lateral Neck Swellings.

Background Lateral neck masses have always been difficult to diagnose without proposing a differential diagnosis. Fine-needle aspiration (FNA) was proposed to be a cost-effective method and less invasive than a tru-cut biopsy and may provide a provisional diagnosis in relation to cytopathology. FNA has also been shown to improve the diagnosis of neck masses such as cervical lymphadenopathy, neck cysts, and parotid masses, whether malignant or benign. This study aims to evaluate the accuracy of FNA cytopathology versus a tru-cut biopsy histopathological examination. Materials and methods This study was conducted retrospectively in King Hussein Medical Hospital, Royal Medical Services, Hashemite Kingdom of Jordan, from January 2019 to January 2024. Ethical approval was taken to conduct this study with reference number 06/2024. All patients included in this study have given verbal and written consent to perform FNA and surgical tru-cut biopsy. The inclusion of patients was based on any person above the age of 16 who underwent an FNA followed by a surgical biopsy to correlate with the primary diagnosis. Exclusion criteria involved any patient who missed one of the above criteria. Statistical analysis was performed using IBM SPSS v29 (IBM Corp., Armonk, NY, US) with significant results considered with a p-value <0.05. Results A total of 107 patients were included in this study. A correlation between FNA results and final histopathological biopsy was done with an accuracy of 90.6%, specificity of 94.3, predictive positive value of 73.6%, andnegative predictive value of 94.3%. There was a statistical significance between FNA and tru-cut biopsy with a p-value of <0.001. Conclusion FNA is a great tool to consider when diagnosing lateral neck swellings. Since it was statistically significant, FNA should be considered for any lateral neck swelling before any surgical tru-cut biopsy for a definitive diagnosis.

Cervical cystic hygroma in adults: a case report

BackgroundsManifestation of cystic hygroma in adulthood is very rare. The rarity of cystic hygroma in adults has caused problems in its diagnosis and management and few studies have reported cystic hygroma in adults.Case presentationIn this study, we reported a rare case with cervical cystic hygroma in adults. We report a 20-year-old Iranian male (Iranian ethnicity) with a diagnosis of right-side neck cystic hygroma and discuss the presentation, diagnosis, and clinical, radiological, and operative aspects of it.ConclusionCystic hygromas are a rare occurrence in adults. They are typically asymptomatic, rarely complicated, and can be mistaken for a cystic neck mass. This study showed that in our case, surgical resection may be a safe and effective treatment for cystic hygroma, with minimal risk of complications during the procedure.

Meta-Analysis of Surgical Treatment versus Sclerotherapy for Management Of Branchial Arch Lesions

Abstract Background Branchial arch lesions (BALS) are uncommon congenital malformations presenting mainly in first 2 decades with neck cysts, sinuses, fistulas, recurrent infections and have low potential to turn malignant. Surgical management of these lesions can be associated with significant risk of complications and recurrence. Sclerotherapy has been described as effective and less invasive alternative option. Aim of the Study is to summarize current available evidence regarding effectiveness and safety of surgery and sclerotherapy as two modalities of treatment for BALS. Methods A systematic review for all interventional studies on management of (BALS) was conducted in multiple medical databases from its inception till March 2021 with inclusion of all studies reporting on either surgical management or sclerotherapy for BALS in humans and reported effectiveness or safety outcomes. Diagnostic and review articles, single case reports and non-human studies were excluded. Proportional meta-analyses were utilized where there is only uncontrolled studies available reporting on outcomes. Assessment of quality was done with use of validated tool relevant to design of primary studies included and risk of bias of studies was assessed statistically. PRISMA Guidelines were followed in reporting of the study. Results A total of 525 studies were retrieved of which only 25 were eligible for inclusion. All included studies were uncontrolled case series; 18 reported on surgery and 7 reported on sclerotherapy The overall quality of included studies were fair to good according to NIH validated tool. Meta-analyses of surgical studies for BALS showed success rate of complete excision of 90%,96%,96% and 98% for first, second, third and fourth branchial arch lesions respectively with complications rates of 19.7%,5%,24% for first, second and third arch lesions. The rates of recurrence were 11.2%,2%,5%,1% for first to fourth arch lesions in order. The corresponding success rates of completed resolution for sclerotherapy were 86% with complications rates of 8% all of which were minor complications. There were no recurrences but recognized incomplete resolution. Conclusion Both surgery and sclerotherapy have satisfactory success in terms of complete excision/resolution of BALS. The risks of complications howeverseem to be more significant with surgical management however no controlled studies were available to allow for definitive conclusions. Further studies with standardized diagnostic criteria and treatment techniquesare needed to allow for prioritizing treatment lines based on conclusive evidence.

Robot‐assisted resection of lateral neck cysts using a postauricular approach

Robot‐assisted resection of lateral neck cysts using a postauricular approach

Metastatic Papillary Thyroid Microcarcinoma Presenting as a Branchial Cleft Cyst in Young Female.

Though aetiology of lateral neck masses is complex, branchial cleft cyst is the second most common congenital lesions of the neck next only to thyroglossal duct cysts. Rarely ectopic thyroid tissue within a branchial cleft cyst may develop into primary papillary carcinoma, and even more rarely it may harbour metastases of primary thyroid papillary carcinoma. We report a rare case of lateral cystic neck mass in a 24-year-old female patient diagnosed as metastatic PTC. The patient was diagnosed after she underwent surgical excision of branchial cleft cyst. Later prospectively the patient underwent total thyroidectomy which revealed papillary thyroid micro invasive carcinoma.

Malignancy and "Violated Neck" Rates in Consecutive Cohort of 79 Adult Patients With Solitary Cystic Neck Mass-Lessons Learned and Recommendations for Clinical Practice Guidelines.

The neck region is a common site for solitary cystic neck mass (SCNM) of various etiologies, including congenital, inflammatory, and neoplastic. In adults, the primary focus is excluding malignancy. The objective of this study was to retrospectively analyze the accuracy of available diagnostic technologies for the differentiation of benign and malignant SCNM in adult patients. The study aimed to develop new clinical practice guidelines for evaluating and managing SCNM. The primary predictive variables were the diagnostic utilities of fine-needle aspiration cytology (FNAC), ultrasound (U/S), multislice computed tomography, and magnetic resonance imaging. The study's endpoint was the overall diagnostic accuracy in differentiating between benign and malignant SCNM. The final diagnosis was based on histopathology. The study included 79 adult patients: 55 (69.62%) male and 24 (30.38%) female ( P <0.05). The mean age at presentation was 42.1 years (range: 18-84 years). Solitary cystic neck mass was distributed in the anterior neck region in 30 (37.97%) patients and the posterolateral neck regions in 49 (62.03%) patients ( P <0.05). The posterolateral neck regions had a significantly higher rate of malignant SCNM than the anterior neck region [19/49 (38.78%) versus 1/30 (3.33%)] ( P <0.05). There was no statistically significant difference between the U/S+FNAC and U/S+FNAC+multislice computed tomography and/or magnetic resonance imaging groups in differentiating benign and malignant SCNM (40/42 versus 36/37, P >0.05). "Violated neck" was recorded in 2 cases. A systematic investigation protocol should be applied to evaluate adult patients with SCNM.

Validation of the VisionArray® Chip Assay for HPV DNA Testing in Histology Specimens of Oropharyngeal Squamous Cell Carcinoma

BackgroundThe detection of human papillomavirus (HPV) has several implications in the diagnostic work-up and management of oropharyngeal squamous cell carcinoma (OPSCC). The choice of HPV detection assay and testing algorithms differ across institutions and vary in cost, detection targets, technical feasibility, and turnaround time. In this study, we aimed to validate the VisionArray® HPV Chip for formalin-fixed and paraffin-embedded (FFPE) samples of OPSCC using the previously applied standard pan-HPV DNA PCR assay as a reference.MethodsThe validation cohort consisted of FFPE tissue samples from patients previously diagnosed with HPV DNA-positive OPSCC (n = 80), HPV DNA-negative OPSCC (n = 21), and a benign group of tumor samples consisting of Warthin’s tumors (n = 20) and branchial cleft cysts of the lateral neck (n = 14). All samples were tested with p16 immunohistochemistry, pan-HPV DNA PCR, and the VisionArray® HPV Chip.ResultsThe overall sensitivity and specificity of the VisionArray® HPV Chip assay were 100% [95% CI 95.5%; 100.0%] and 96.3% [95% CI 87.3%; 99.6%] and the positive predictive value and negative predictive value were 97.6% [95% CI 91.5%; 99.7%] and 100% [95% CI 93.2%; 100%], respectively.ConclusionsThe VisionArray® HPV Chip assay can be recommended for high-risk HPV testing in FFPE tissue samples from OPSCC, providing both a fast and simultaneous genotyping for 41 clinically relevant HPV types.

A giant dermoid cyst in the floor of the mouth: a case report

Dermoid cysts are slow-growing cystic masses that are lined by stratified squamous epithelium and contain skin appendages. Dermoid cysts in the floor of the mouth account for less than 0.01% of all neck and oral cavity cysts. They can be either congenital or acquired. We report a case of a 25-year-old male, a final-year engineering student, who came to our outpatient department with complaints of swelling in the mouth and weight loss for 4 years. On examination, a large cystic swelling in the floor of the mouth, approx. 5x6 cm, obscuring the oropharynx, was seen. USG and CECT of the neck suggested ranula and plunging ranula in the right submandibular space, respectively. He underwent a combined (debulking and enucleation) submandibular cystic swelling excision through a transoral approach under general anesthesia guided by awake fiber optic nasal intubation. The intraoperative and postoperative periods were uneventful. Histopathologic examination of the resected tissue specimen suggested a dermoid cyst. The patient recovered well during the 1-month follow-up, and he gained weight up to 2.5 kg in a month of treatment. Dermoid cysts are very rare cystic lesions on the floor of the mouth. Surgery is the most curable method of treatment. A proper clinical examination with imaging guidance is necessary for accurate delineation of the cyst. Large submandibular cystic lesions can be excised by combining debulking and enucleation through a transoral approach, with a good cosmetic and functional outcome.

Case Report: 14 Years-Old Boy with Paraplegia and Aneurysmal Bone Cysts of Neck who Responded to Anti-Tuberculosis Treatment

This article discusses a rare case of Aneurysmal Bone Cyst (ABC) affecting the cervical spine, presenting with neck pain and progressive weakness in all extremities. A 14-year-old boy experienced these symptoms for three years without any history of trauma. Physical examination revealed weakness and tenderness in the cervical vertebrae. MRI showed cervical compression, paravertebral abscess, spinal nerve swelling, and canal stenosis, suggestive of tuberculosis spondylitis. The surgical intervention involved laminectomy and tumor debulking, confirming the diagnosis of a aneurysmal bone cyst. Despite initial motor deficits, anti-tuberculosis treatment significantly improves motor function and neck mobility over several weeks. This case underscores the rarity of cervical spine involvement in aneurysmal bone cyst and highlights the importance of prompt diagnosis and treatment to prevent neurological complications and achieve favorable outcomes. The study emphasizes considering aneurysmal bone cyst as a potential differential diagnosis for lytic lesions involving the spine in young patients, emphasizing the need for vigilance in clinical practice.

Cases of difficult-to-access benign tumors with the potential risk for bone fracture

During the period from 2022-2023, three patients underwent surgical treatment involving curettage and bone grafting at our clinic (2 females and 1 male) due to hip pain. In two of them, a non-ossifying fibroma of the femoral neck and acetabulum was observed, while in the third patient, a bone cyst in the femoral neck was established. Due to possible fractures in these areas, the patients underwent surgery involving curettage and bone grafting with a synthetic bone substitute. Postoperatively, the patients had no pain and full range of motion.

Diagnostic spectrum of cysts of head and neck: Case series and review of literature

One of the foremost problems that brings patients to Otorhinolaryngology clinics are cystic swellings in the head and neck region. We aimed to study the presentation, configuration of cystic swellings of head and neck for diagnosis and management. A retrospective study of 30 patients belonging to diverse age group and presenting with complaints of swelling in the craniofacial domain to the otorhinolaryngology outpatient department was conducted. Based on the characterization of cystic swellings of head and neck, most turned out to be usually benign. The most common cyst was epidermoid cyst (56%), followed by second arch branchial cyst (26%). A single case each of nasopalatine cyst and intra-parotid lymphatic cyst was also reported. Swellings in the head and neck can have various presentations. Cytologic examination of head and neck cysts along with pre-operative clinical examination and imaging offer imperative information concerning the nature of the cystic lesions, and may rarely lead to any misdiagnosis.

Metastatic papillary thyroid carcinoma masquerading as lymphangioma: A rare case report and review of literature

ABSTRACT Papillary thyroid carcinoma coexisting with lymphangioma is a rare presentation of a cystic neck mass. Here, we report a case of papillary thyroid carcinoma masquerading as lymphangioma in the neck clinically and radiologically. Our patient was a 31-year-old man who presented with swelling on the left side of the neck for four months. A detailed history and investigation are summarized, and a review of published literature on similar cases is obtained. The initial computed tomography (CT) scan reported it as lymphangioma, and the fine-needle aspiration cytology (FNAC) reported it as a cystic lesion. However, the excision biopsy showed a picture of metastatic papillary carcinoma of the thyroid with cystic changes and associated lymphangioma. The patient finally underwent total thyroidectomy, which again revealed multifocal papillary thyroid carcinoma with capsular invasion and lymph node metastasis on histopathological examination (HPE). Primary occult carcinoma of the thyroid with metastatic deposits presenting as lymphangioma is a very rare presentation of a cystic neck mass, and very few cases have been reported in the English language literature.

Now you see it, now you do not!! - a case report and review of literature of bilateral jugular venous phlebectasia

Background: Jugular vein phlebectasia is a rare entity seen in children and is often an incidental finding presenting as a soft, cystic painless neck swelling that becomes prominent on coughing or straining and disappears on rest. It is usually managed conservatively. Case Presentation: We report a case of an 8-year-old boy who visited us on an outpatient basis with a history of cough with neck swelling. Doppler ultrasound helped clinch the diagnosis of bilateral jugular venous phlebectasia. Conclusion: It is paramount that clinicians consider this differential of jugular phlebectasia for neck swellings to avoid unnecessary investigations.

A Case of Brachial Plexus Schwannoma Presenting as a Cystic Neck Swelling

Schwannomas are benign tumours arising from Schwann cells of the neural sheath. They are rarely seen to arise from the brachial plexus. Brachial plexus schwannomas present as a swelling over lateral neck, supraclavicular region or axilla. Symptoms may include pain, sensory changes, weakness etc. Around 5% of these schwannomas may turn malignant. Although rare, cystic neck swellings can be due to cystic degeneration of a schwannoma. A preoperative evaluation is of utmost importance and in cases of neck swellings which are producing symptoms, a pre-operative MRI should be done to reach the diagnosis before taking the patient in the OT. Presented is a case of lateral neck swelling with mild tingling sensation over arm of the same side.

What is the annual risk of infection in congenital midline neck cysts in children? Thyroglossal duct cysts versus dermoid cysts

IntroductionMidline neck lumps in children are mostly found to be thyroglossal duct cysts or dermoid cysts. Thyroglossal duct cysts often have an associated sinus tract which may connect all the way to the foramen caecum on the tongue, while dermoids have no such connection. This study aims to estimate the annual infection risk for midline neck cysts based on our patient series, and to see if this differs between thyroglossal duct cysts and dermoid cysts. MethodsAll children seen at the Royal Hospital for Children, Glasgow who underwent surgical excision of a midline neck cyst between 1st January 2017 and 31st December 2021 were identified. In those whose cyst had been infected prior to surgical excision, the age at which the first episode of infection occurred was recorded and used to calculate a survival curve. ResultsWe identified 53 children (29 male, 24 female) aged 1–16 years (median 4) at the time of surgical excision. There were 26 thyroglossal and 24 dermoid cysts, plus 2 with indeterminate histology and 1 lymph node. Of the 24 dermoids, 4 suffered infection prior to surgery (17%), and 2 of these recurred after surgery (8%). Of the 26 thyroglossal cysts, 16 suffered infection prior to surgery (62%) and 5 of these recurred (19%). 78% of thyroglossal and dermoid cysts had at least 1 episode of infection by age 10 years. DiscussionIn a child with a congenital midline neck cyst that has never been infected, deferring surgery for a year comes with a 7.8% risk that the cyst will get infected.

Minimally Invasive Management of Neonatal Piriform Fossa Sinus Tract: A Scoping Review.

In rare situations, neonates may present with respiratory distress and neck swelling from a piriform fossa sinus tract (PFST) lesion. Open surgical excision of PFST may be associated with higher complication rates, especially in neonates. Endoscopic treatment has been shown to have high success rates in older children, but neonatal outcomes appear to be less promising. The objective of this study was to review the existing literature on endoscopic treatment of PFST in neonates. PRISMA-ScR guidelines for scoping reviews were employed. Medline and Embase databases were searched in accordance with a detailed search strategy. Nine studies met criteria for inclusion. A total of 21 neonates with PFST treated endoscopically were reviewed. Mean age at onset of symptoms was 11.6 days. Neck swelling was the most common presenting symptom (20/21, 95%), followed by respiratory distress (6/9, 66.6%). Success rate after initial endoscopic treatment was 57% (12/21); among those, seven patients required additional concurrent treatments such as neck/pharyngeal swelling decompression or sclerotherapy. Nine patients underwent a second intervention (43%) and three patients (14%) required three interventions. Notably, 90% of patients (19/21) achieved success with only minimally invasive approaches. Two patients underwent open salvage surgical excision after recurrence following initial endoscopic treatment. Neonates with PFST and cystic neck masses are prone to recurrence after initial minimally invasive endoscopic treatment; however, high success rate may be achieved after repeat interventions. Adjunctive measures to optimize outcome may include swelling decompression w/wo sclerotherapy to cause fibrosis and postoperative nasogastric tube feeding. NA Laryngoscope, 134:2585-2591, 2024.