The incidence of malignancy in clinically benign cystic lesions of the lateral neck: our experience and proposed diagnostic algorithm.

AIM: Solitary cystic masses of the lateral neck in an adult patient can pose a diagnostic dilemma. Malignancy must be ruled out since metastases arising from H&N cancers may mimic the presentation of benign cystic masses. Only a small number of studies have investigated the diagnostic management and malignancy rate of clinically benign solitary cervical cystic lesions. There are no established guidelines for the diagnostic evaluation. METHODS: Retrospective review of the clinical, cytological, radiological, and pathological records of all adult patients (> 18 years) operated on for second branchial cleft cysts (BrCC) between 1/2008-2010/2016. Patients with apparent primary H&N malignancy, history of H&N cancer or irradiation, preoperative fine needle aspiration (FNA) of highly suggestive or confirmed malignancy, missing pertinent data, or age less than 18 years were excluded from analysis. RESULTS: 28 patients were diagnosed as having BrCC. The diagnosis was based on clinical findings, FNA cytology, and typical sonographic features. The histologic analysis determined an overall rate of malignancy of 10.7% (3/28): two patients had metastatic papillary thyroid carcinoma, and one patient had metastatic tonsillar squamous cell carcinoma. Purely cystic features on pre-operative ultrasound was the only significant predictor for true BrCC on final histology (p = .02). CONCLUSIONS: Occult malignancy is not rare among adult patients presenting with a solitary cystic mass of the lateral neck. A diagnostic algorithm is proposed. Further studies are needed to establish the appropriate workup and management of an adult patient presenting with a solitary cystic mass of the lateral neck.

Bronchogenic cancer: It still exists.

OBJECTIVES/HYPOTHESIS: Branchial cleft cysts rank among the most common differential diagnoses of cystic cervical masses. Rarely, classic cystic structures exhibit a squamous cell carcinoma differentiation that represents a bronchogenic carcinoma. The existence of bronchogenic carcinoma is controversial due to the lack of systematic immunohistologic workup. The present study aimed to identify the clinical and immunohistologic features of bronchogenic carcinoma to clearly distinguish this entity from other cystic cervical masses. METHODS: Immunohistologic (epidermal growth factor receptor; cytokeratin 5, 6, 7, 13; and p16) and epidemiologic assessments were performed for branchial cleft cysts (n = 63), bronchogenic carcinomas (n = 5), cystic metastasized oropharyngeal carcinomas (n = 97), and carcinomas of unknown primary (n = 51). The study was conducted as a retrospective case series study with comparison. RESULTS: The patients with bronchogenic carcinomas differed significantly in age and in the number of involved lymph nodes compared with the cystic metastasized oropharyngeal carcinoma (and carcinoma of unknown primary) patients. Regular histologic wall structures were only observed in the bronchogenic carcinomas and branchial cleft cysts. Solitary cytokeratin-7 staining was only observed in the bronchogenic carcinomas, and all of the bronchogenic carcinomas were p16 negative. CONCLUSIONS: The existence of bronchogenic carcinoma seems to be plausible based on clinical findings. Cytokeratin-7 and p16 staining might be helpful in the diagnostic workflow. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:638-642, 2016.

Distribution of branchial anomalies in a paediatric Asian population.

INTRODUCTION: The objective of the present study was to review the distribution and incidence of branchial anomalies in an Asian paediatric population and highlight the challenges involved in the diagnosis of branchial anomalies. METHODS: This was a retrospective chart review of all paediatric patients who underwent surgery for branchial anomalies in a tertiary paediatric hospital from August 2007 to November 2012. The clinical notes were correlated with preoperative radiological investigations, intraoperative findings and histology results. Branchial anomalies were classified based on the results of the review. RESULTS: A total of 28 children underwent surgery for 30 branchial anomalies during the review period. Two children had bilateral branchial anomalies requiring excision. Of the 30 branchial anomalies, 7 (23.3%) were first branchial anomalies, 5 (16.7%) were second branchial anomalies, 3 (10.0%) were third branchial anomalies, and 4 (13.3%) were fourth branchial anomalies (one of the four patients with fourth branchial anomalies had bilateral branchial anomalies). In addition, seven children had 8 (26.7%) branchial anomalies that were thought to originate from the pyriform sinus; however, we were unable to determine if these anomalies were from the third or fourth branchial arches. There was inadequate information on the remaining 3 (10.0%) branchial anomalies for classification. CONCLUSION: The incidence of second branchial anomalies appears to be lower in our Asian paediatric population, while that of third and fourth branchial anomalies was higher. Knowledge of embryology and the related anatomy of the branchial apparatus is crucial in the identification of the type of branchial anomaly.

The management of pediatric neck masses.

Neck masses are a common clinical concern both in adults and children. The differential diagnosis is quite broad, from congenital lesions to malignant tumors. Based on the different pathologic diagnosis, the treatments are varied. To the best of our knowledge, limited reports, which specifically discuss the incidence and distribution of neck diseases in early childhood, have been published. Because of the great population in China, a thorough review of the previous clinical data for pediatric neck masses might be potentially valuable for oral and maxillofacial surgeons, which might provide a deeper understanding and better the accuracy of our clinical diagnosis and management. In this article, a 10-year retrospective review was completed; the whole cases were diagnosed and treated in the same major clinical institute in east China, which might represent as a typical cohort for the patient population and serve as a reference for future clinical management.

Neck masses: diagnostic analysis of 630 cases in Turkish population.

Neck masses can be classified into three main categories: congenital, inflammatory and neoplastic. Our aim was to determine the distribution of diagnosis in patients who were followed-up for a neck mass and had undergone surgery for diagnostic indications. Six hundred and thirty cases referred to the Otorhinolaryngology and Head Neck Surgery Department of Haseki Research and Training Hospital between January 2005 and February 2012 with a neck mass who underwent excisional or incisional biopsy to establish a histopathologic diagnosis were retrospectively evaluated. Patients with a diagnosis of upper aerodigestive tract malignancy were excluded from the study. As well as the patients with thyroid masses were excluded. Only unknown primary neck masses were included in the study. The neck masses were categorized as inflammatory (33.49 %), congenital (18.9 %) or neoplastic (47.6 %). Neoplastic masses were either benign (51 %) or malignant (49 %) tumors. The most common causes were tuberculous lymphadenitis (40.28 %) among inflammatory masses, thyroglossal duct cysts (32.77 %) among congenital masses, pleomorphic adenoma (22.33 %) among benign neoplastic masses, and lymphoma (20 %) among malignant neoplastic masses. The most common types of mass were congenital in the 0-20 year age group, benign neoplastic in 21-40-year-old and malignant neoplastic in the >40-year group. Any neck mass, especially in an elderly patient, should be managed with caution as a considerable proportion may be malignant. In children and adolescents, a neck mass requiring surgery is most likely to be congenital. Tuberculosis should be considered as a cause of a neck mass due to a long-term inflammatory process in a developing country.

Caracterización epidemiológica y clínica de pacientes operados con diagnóstico de quiste branquial / Epidemiological and clinical characterization of operated patients diagnosed with branchial cyst

Branchial Cysts are uncommon anomalies in regular clinical practice. However, among congenital cervical cysts, they represent about 30% from total. Objective: Characterize patients diagnosed with operated branquial cyst in our clinical center, and correlate clinic, imaging and final diagnose. Material and methods: Retrospective descriptive study of discharged patients diagnosed as cervical cysts, between January 2005 and July 2011, at Hospital Clinico Universidad de Chile. Selection of Clinical records with final diagnose of branchial cyst were selected. Age, sex, clinical story, imaging exams, pre-operative and post-operative diagnoses, and biopsy report were registered. Results: from a total of 149 cervical cysts, 31 (20,8%) were branchial cysts. Man 45% and women 55%. By age, 9 (29%) were < 15 years old (average: 6,69 years) and 22 (70,9%) > 15 years (average: 33,7 years). Lateral cervical mass was the most common clinical manifestation. Regarding Imaging study, 15 cervical ultrasounds (sensibility 0,86 and specificity 0,98) and 13 cervical CTA scans (sensibility 0,92 and specificity 0,94) were conducted. In 9 patients, imaging studies weren't conducted for the clinical diagnose (sensibility 0,77 and specificity 0,98). Correlation of pre-operative and post-operative diagnose was 87%. Discussion: According to literature, presentation age is generally during childhood; however, in our statistics it presented during adult age, which could be explained due to the main focus our medical center has for adult population. Most common clinical presentation was lateral neck mass, which had a good clinical correlation, however improves with imaging studies. (AU)

[Brachial cleft cyst]. / Torbiel boczna szyi.

Brachial cleft cyst is a congenital anomaly arising from persistent elements of branchial apparatus. It may assume the form of cyst, sinus or fistula and constitutes 30% of all congenital anomalies of the neck region. Brachial cleft cyst is usually recognized in patients before the 5th year of age, but it may appear in patients between 20 and 40, when it enlarges owing to infection. It reveals then as a smooth, resilient tumor in lateral region of the neck. Ultrasonography, computerized tomography and magnetic resonance may be used to evaluate and differentiate these lesions as well as to reveal the presence of fistula, which is important to plan the proper surgical treatment. The only effective treatment is total surgical excision. The lack of treatment puts a patient at risk of infections, while incomplete removal might result in recurrence.

Comportamiento del quiste branquial en pacientes del Hospital General Docente Ciro Redondo García, Artemisa, 1993-2009 / Behavior of branchial cyst in patients admitted in the \"Ciro Redondo García\", General Teaching Hospital, Artemisa municipality, 1993-2009

El quiste branquial de origen congénito que aparece en la región lateral del cuello es, con frecuencia, motivo de consulta. Se tuvo como objetivo determinar el comportamiento de los quistes branquiales en el Hospital Ciro Redondo García, de Artemisa en el periodo de 1993 al 2009. Se realizó un estudio descriptivo transversal de los quistes branquiales diagnosticados en pacientes intervenidos quirúrgicamente en el Servicio de Cirugía Maxilofacial. Se estudiaron la edad, el sexo, el color de la piel, el lado del cuello afectado, el resultado histopatológico y los medios auxiliares empleados. Se encontraron 12 quistes branquiales que afectaron el 50 por ciento de ambos sexos, un 75 por ciento a pacientes entre 15 y 30 años y un 75 por ciento de la piel blanca, un 66,7 por ciento afectó el lado derecho del cuello y en un 100 por ciento de los casos se utilizó la biopsia y el ultrasonido como medios auxiliares para su diagnóstico. Se encontró epitelio escamoso estratificado en un 100 por ciento de los quistes y en un 91,6 por ciento el tejido linfoide. No se encontró predilección por el sexo, la mayoría de los pacientes eran menores de 30 años, de piel blanca y presentaban los quistes en el lado derecho del cuello. En todos los pacientes se empleó la biopsia y el ultrasonido como medios auxiliares de diagnóstico. El epitelio escamoso estratificado y el tejido linfoide fueron los hallazgos histopatológicos más relevantes(AU)

The congenital branchial cyst appearaing in the lateral region of the neck is frequently consultation reason. The aim was to determine the behavior of the branchial cysts in the patients admitted in the Ciro Redondo García General Teaching Hospital of Artemisa municipality from 1993 to 2009. A cross-sectional and descriptive study was conducted of the branchial cysts diagnosed in patients operated on in the Maxillofacial Surgery Service. Study variables were: age, sex, the skin color, neck involved side, histopathological result and the auxiliary means used. There appear 12 branchial cysts involving the 50 per cent of both sexes, a 75 per cent aged between 15 and 30 and a 75 per cent of white skin, a 66,7 per cent involved the neck right side and in a 100 per cent of cases authors used biopsy and ultrasound as auxiliary means for its diagnosis. There was a stratified squamous epithelium in a 100 per cent of cysts and in a 91,6 per cent the lymphoid tissue. There was not predominance of sex, most of patient were aged under 30, white skin and had cysts in the neck right side. In all patients authors used the biopsy and ultrasound as diagnostic auxiliary means. The stratified squamous epithelium and the lymphoid tissue were the more relevant histopathological findings(AU)

Branchial anomalies in children.

BACKGROUND: Branchial cleft anomalies are the second most common head and neck congenital lesions seen in children. Amongst the branchial cleft malformations, second cleft lesions account for 95% of the branchial anomalies. This article analyzes all the cases of branchial cleft anomalies operated on at Great Ormond Street Hospital over the past 10 years. METHODS: All children who underwent surgery for branchial cleft sinus or fistula from January 2000 to December 2010 were included in this study. RESULTS: In this series, we had 80 patients (38 female and 42 male). The age at the time of operation varied from 1 year to 14 years. Amongst this group, 15 patients had first branchial cleft anomaly, 62 had second branchial cleft anomaly and 3 had fourth branchial pouch anomaly. All the first cleft cases were operated on by a superficial parotidectomy approach with facial nerve identification. Complete excision was achieved in all these first cleft cases. In this series of first cleft anomalies, we had one complication (temporary marginal mandibular nerve weakness. In the 62 children with second branchial cleft anomalies, 50 were unilateral and 12 were bilateral. In the vast majority, the tract extended through the carotid bifurcation and extended up to pharyngeal constrictor muscles. Majority of these cases were operated on through an elliptical incision around the external opening. Complete excision was achieved in all second cleft cases except one who required a repeat excision. In this subgroup, we had two complications one patient developed a seroma and one had incomplete excision. The three patients with fourth pouch anomaly were treated with endoscopic assisted monopolar diathermy to the sinus opening with good outcome. CONCLUSION: Branchial anomalies are relatively common in children. There are three distinct types, first cleft, second cleft and fourth pouch anomaly. Correct diagnosis is essential to avoid inadequate surgery and multiple procedures. The surgical approach needs to be tailored to the type of anomaly of origin of the anomaly. Complete excision is essential for good outcomes.

Pattern of congenital neck masses in a Kenyan paediatric population.

BACKGROUND: The distribution of congenital neck masses varies between countries and is important in diagnosis and treatment modalities. Data from Africa is scarce, and altogether absent from Kenya. OBJECTIVE: To describe the pattern of congenital masses in a Kenyan paediatric population. SET UP: Kenyatta National Hospital, Nairobi Kenya. STUDY DESIGN: Prospective descriptive cross-sectional. METHODOLOGY: Children aged 15 years and below with neck masses who presented to various surgical clinics and wards at the Kenyatta National Hospital between December 2006 and April 2007 were included in the study. They were examined for age, gender, type and location of the neck mass. Mode of investigation and final diagnosis were recorded. Data was analyzed by using statistical package for social sciences. Descriptive statistics were applied to determine means, frequencies and modes. Ninety-five percent confidence interval was used and p value of 0.05 taken as significant. Data are presented in form of tables. RESULTS: Two hundred and thirty-five children (129 male) with neck masses were examined. Fifty-one (22%) of these masses were congenital. Thyroglossal duct cysts were the most common (29%) followed by cystic hygromas (21%) and branchial cleft cysts (20%). Fifty-one percent of the masses were present at birth. The midline was the most common location (31.4%) followed by anterior border of sternocleidomastoid (27.5%) and submandibular region (19.6%). Ultrasound was the commonest diagnostic investigation. CONCLUSION: Congenital defects constitute an important differential diagnosis for paediatric neck masses in Kenya. Thyroglossal duct cysts, cystic hygromas and branchial cleft cysts are the most prevalent occurring most commonly in the midline and anterior border of sternocleidomastoid muscle. An understanding of the distribution of these masses improves diagnosis, preoperative decision making and their overall management.

Bilateral first and second branchial cleft fistulas: a case report.

Branchial cleft anomalies--which include branchial cysts, sinuses, and fistulas--are uncommon developmental defects of the neck. Approximately 2 to 3% of cases are bilateral; bilateral presentations appear to have a familial component. Only 5 cases of bilateral branchial cleft fistulas have been reported in the English-language literature, and only 1 case of simultaneous first and second branchial cleft fistulas has been previously reported. We report what to the best of our knowledge is the second case of bilateral first and second branchial cleft fistulas.

Congenital neck masses: a descriptive retrospective study of 252 cases.

PURPOSE: This retrospective study was conducted to analyze congenital neck masses in Jordanians compared with international findings. PATIENTS AND METHODS: The records of patients with congenital neck masses between 1991 and 2002 were retrieved from the Department of Pathology, Jordan University of Science and Technology, and analyzed for age, gender, location, clinical features, and treatment. RESULTS: Within the 12-year period of the study, a total of 2,063 neck mass lesions were found; of these, 252 (12%) were congenital masses. These cases were distributed into 166 (66%) midline, 55 (22%) lateral, and 31 (12%) entire neck masses. The most frequent mass was thyroglossal duct cyst (fistulas) (53%), followed by cysts (fistulas) of the branchial apparatus (22%), dermoid cysts (11%), hemangiomas (7%), and 1ymphangiomas (6%). The majority of branchial arch anomalies (85%) were of the second arch. The mean age of patients was 16 years, with the greatest number of cases (38%) in the first decade. The male-to-female ratio was 1:1.2, with most lesions affecting females. The majority of lesions presented with painless neck swelling, and all lesions were surgically excised. CONCLUSIONS: The overall frequency and age distribution of congenital neck masses in northern Jordanians are similar to international findings. However, the gender distribution and relative frequency of individual types of neck masses are somewhat different from those in other countries. These differences may be attributed to genetic and geographic differences.

Branchial cyst side predilection: fact or fiction?

OBJECTIVES: It is a common teaching that two thirds of branchial cysts occur on the left side of the neck. We reviewed the evidence behind this statement and assessed whether they actually do present twice as often on the left side. METHODS: Our study comprised two parts: (1) a historical review of branchial cysts and (2) a retrospective review of 91 histologically confirmed cases operated on at two British hospitals in the years 1999 to 2005. The side of the branchial cyst was recorded. RESULTS: Early studies on branchial cysts did not always rely upon histologic diagnosis; the definition of a branchial cyst has varied throughout medical history. The statement "two thirds of branchial cysts occur on the left" is based upon these early studies in which the definition was variable. In our study, right-sided branchial cysts were actually more common than left-sided branchial cysts (53.8% versus 45%; chi2 test, p = .399). One percent were bilateral. CONCLUSIONS: Ours is the largest single study in the past 50 years to look at the side predilection of branchial cysts in terms of histologic proof. We propose that branchial cysts may not present more commonly on the left side of the neck, as is commonly taught in medical schools.

Branchial cyst: an often forgotten diagnosis.

OBJECTIVE: To study the clinical presentations, diagnosis and management of patients with the pathological diagnosis of branchial cysts. METHODS: This was a retrospective analysis of the records of 33 patients with the diagnosis of branchial cyst, seen between 1987 and 2003 at the General Surgical Unit of Jordan University Hospital. RESULTS: Thirty-four cases of branchial cysts were seen in 33 patients: 22 females and 11 males. There was a wide range in age (1-57 years), but the majority (25 patients) were in their second or third decades of life. Thirty-one cysts occurred in the classical site. The same number of branchial cysts occurred on the right and left sides of the neck (17 on the right and 17 on the left). Correct clinical diagnosis was made in only 14 cases (41.2%). CONCLUSION: Branchial cysts are frequently incorrectly diagnosed and forgotten in the differential diagnosis. Thus, the diagnosis is often delayed, resulting in the mismanagement of these patients. Branchial cyst should be suspected in any patient with a swelling in the lateral aspect of the neck, regardless of whether the swelling is solid or cystic, painful or painless. Fine needle aspiration cytology will accurately demonstrate the cystic nature. The presence of cholesterol crystals and/or epithelial cells in the aspirate will suggest the diagnosis of branchial cyst.

Branchiogenic carcinoma--conceptual or true clinico-pathological entity?

The existence of branchiogenic carcinoma remains controversial. According to some authors, this malignancy is more conceptual than a true clinicopathologic entity. The originally proposed diagnostic criteria of branchiogenic carcinoma have been subsequently challenged. Many reports regarding primary branchiogenic carcinoma have failed to provide sufficient evidence to distinguish this entity from nodal metastases arising from unrecognized primary tumours. There is growing evidence that the majority of branchiogenic carcinomas are in fact cystic metastases from oropharyngeal carcinoma, most commonly originating in the tonsils, and not true carcinomas arising in a branchial cleft cyst. The missing link between branchial cyst and branchiogenic squamous cell carcinoma could be fulfilled by the occurrence of in situ branchial cyst carcinomas, yet such cases are extremely rare. Isolated cystic neck lesions, necessitate a thorough search for a primary tumour, similarly to other occult primaries presenting with cervical metastases. The treatment of cervical cyst with dysplasia or carcinoma in situ includes complete surgical excision. The true branchiogenic carcinomas should be approached with postoperative irradiation to the half neck. A cervical metastatic cystic squamous carcinoma of unknown origin should be treated as for other cases of occult primaries, i.e. with surgery and radiotherapy. The data on the prognosis of branchiogenic carcinoma are scarce, though long-term survival has been reported. Further histopathologic and clinical studies are warranted in order to better understand the biology and natural history of cervical cystic lesions. The existence of true branchiogenic carcinoma remains to be verified with new clinical and molecular criteria.

[Branchiogenic cysts registered at the Otolaryngology Clinic of Medical University in Wroclaw in years 1989-1998]. / Torbiele skrzelopochodne (cystis branchiogenes) w materiale Kliniki Otolaryngologicznej AM we Wroclawiu w latach 1989-1998 r.

Lateral branchiogenic cysts are relatively rare among neck tumours. However they belong to the most frequent developmental malformation in this area. Their etiology and pathogenesis is not fully explained yet. Over the period of ten years there were 76 patients hospitalized in our clinic with the diagnosis of the lateral branchiogenic cyst. Its prevalence was similar in both sexes and ranged from 3 months to 62 years of age. More than half of the patients were children. In 2 cases, a rare primary cancer rising from a branchiogenic cyst was diagnosed. Positive family history was observed in two children. Surgery was performed in 59 patients. Unsatisfactory results of the surgery were noted in 6 cases and 4 of them were reoperated because of the recurrence. In the case of brachiogenic cysts a full oncologic diagnostics should be performed, as it is done with neck tumour management. The procedures, which enable us to estimate character and extent of a lesion and determine the proper surgical treatment, should include ultrasonography, fine-needle biopsy or CT.

[Tumors of the submandibular triangle]. / Guzy trójkata podzuchwowego.

Analysed material consists of 180 patients with different kind of submandibular triangle tumors, excluded disturbances of the submandibular gland. All these patients were treated in ENT Department of County Hospital No 1 in Rzeszów in 1974-1993. Among 180 patients in 97 (54%) cases, the presence of inflammatory tumors were stated: non specific inflammation in 74 (76%) patients and specific inflammation in 23 (24%) patients. In 10 (6%) patients occurred branchial or dermoid cysts. Neoplastic tumors occurred in 73 (40%), malignant tumors in 64 (86%) patients and benign ones in 9 (12%) patients. Among malignant tumors metastatic ones were stated 41 (64%) cases, while primary tumors in 23 (36%). The histology type of tumors were revealed by histology examination.

First branchial cleft cysts presenting as parotid tumors.

Masses of the parotid gland region can be caused by a variety of different conditions, most commonly neoplasms of a benign or malignant nature. A rare cause for parotid tumors is the embryonologic remnant of first branchial cleft cysts. We reviewed branchial cysts for a 10-year period at the three teaching hospitals in Akron, OH. First branchial cleft cysts, or parotid lympho-epithelial cysts, were found to be a very rare condition presenting as parotid tumors. The surgeon should always be aware of these cysts as a possibility in the differential diagnosis of parotid masses in the infant and adult.