between a branchial cyst andacystic metastasis of the headandneck is needed We reporttheir diagnostic workup and treatCase reportsCase 1 TS Chimona et al Figure2 DNA analysis of theaspirated ID: 938226
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presents as an asymptomatic neck between a branchial cyst andacystic metastasis of the headandneck is needed. We reporttheir diagnostic work-up and treat-Case reportsCase 1 T.S. Chimona et al. (Figure2); DNA analysis of theaspirated material showeddiploidy. Although cytology andploidy determination were indica-tive for a benign lesion,the patientunderwent panendoscopy andblind biopsies of WaldeyerÕs ring.Ultrasonography did not revealany thyroid abnormality. Thediagnostic work-up was negativefor malignancy and the cysticlesion was excised and frozen sec-tion analysis was negative for car-cinoma. The excised cystic lesionwas diploid. Fifteen months aftersurgery,the patient has no evi-A 27-year-old man was admittedwith a purulent fistula on the rightexamination,an asymptomaticdle third was present. The computed tomography scan revealedacomplete dermo-pharyngeal fistula. Although,on the basis ofclinical and imaging findings thediagnosis of a branchial fistulawas made,FNA cytology of aspi-rate from the fistula was per-for
med to exclude malignant cellanaesthesia,methylene blue wasand detected in the patientÕs throatwith a flexible endoscope. A smallellipsoid incision was performedaround the fistulaÕs opening andextended along the anterior borderThe fistula was found undertheplatysma,along the anteriorinternal jugular vein. The fistuloustract was carefully dissected toavoid injury of the carotid artery,internal jugular vein,hypoglossaland vagal nerves. The fistulaextended from its skin opening tothe lateral pharyngeal wall inferiortric muscle and was dissected andexcised through its superior point(Figure4). Histological diagnosis confirmed a branchial cleft fistula.18months after surgery.Case 3A 25-year-old man was referredon the right side of the neck. Theswelling had gradually evolved toits current size after several infec-tions. The patient reported a pus-like fluid in his throat during theinfections. Clinical examinationrevealed an immobile,painfulmass,located close to the anteriormuscle in the carotid triangle. Thevenous course of a
ntimicrobialtherapy. Ultrasonography and CTscan demonstrated a cystic lesionin contact with the great vessels ofthe pharynx was noticed. TheFNA biopsy was indicative of aninfected branchial cyst. The lesionwas excised through a wide,transverse cervical incision undergeneral anaesthesia. Althoughcystdissection was quite difficult Figure 1Axial CT scan demonstrating a cystic mass with smooth bor-ders behind the left submandibular salivary gland. Figure 2Branchial cyst cytology. Anucleate keratinized squamous cells.Papanicolaou stain ( Second branchial cleft anomalies in adults surgical excision and recurrentrates for cysts have been reportedin 4% and for branchial fistulas inmalities reported advocate clinicalexamination,imaging studies,FNA cytology and DNA analysisas useful non-invasive tools in themanagement of lateral neck cysts.Recurrent infections and dischargesinus or fistula. It is of great impor-tance,especially in the age groupover 40years,to exclude morebefore excision,even when clinicalA branchial cleft anomal
y,espe-cially a cyst,must be included inthe differential diagnosis of anysents during the first three decadesof life. Imaging studies show thecystic nature of the lesion as wellstructures. Although FNA cytol-ogy as well as DNA ploidy deter-mination seems to improve diag-nostic adequacy,a large series is References1.Torsiglieri AJ Jr,Tom LW,Ross AJ3rd,Wetmore RF,Handler SD,PotsicWP. Pediatric neck masses:guidelines for evaluation. Int J Pediatr2.Ford GR,Balakrishnan A,Evans JN,Bailey CM. Branchial cleft and pouch3.Chandler JR,Mitchell B. Branchialcleft cysts,sinuses,and fistulas.Otolaryngol Clin North Am.4.Harnsberger HR,Mancuso AA,anomalies and their mimics:comput-ed tomographic evaluation. logy5.Golledge J,Ellis H. The aetiology oflateral cervical (branchial) cysts:past6.Bath AP,Murty GE,Bradley PJ.Branchial cyst Ð to endoscope or not?7.Flanagan PM,Roland NJ,Jones AS.with features of branchial cysts.JLaryngol Otol8.Girvigian MR,Rechdouni AK,ZegerGD,Segall H,Rice DH,Petrovich Z. Squamous cell carcino-cyst. 9.Andrews PJ
,Giddings CE,Su AP.Management of lateral cysticswellings of the neck,in the over 40sÕ 10.Agaton-Bonilla FC,Gay- Escoda C.cleft cysts and fistulae. A retro-spective study of 183 patients. Oral Maxillofac Surg11.Koeller KK,Alamo L,Adair CF,Smirniotopoulos JG. Congenitalcystic masses of the neck:radiologic-graphics12.Orell SR,Sterrett GF,Walters MN-I,Whitaker D.Manual and atlas of fineneedle aspiration cytology,2Churchill Livingstone,Edinburgh;13.Regauer S,Gogg-Kamerer M,BraunH,Beham A. Lateral neck cystsÐ the branchial theory revisited. Acritical review and clinicopathologicalsis on cytokeratin expression. 14.Sheahan P,OÕleary G,Lee G,Fitzgibbon J. Cystic cervical metas-tases:incidence and diagnosis usingfine needle aspiration biopsy.Otolaryngol Head Neck Surg15.Nordemar S,Hgmo A,Lindholm J,. The clinical value of imagecytometry DNA analysis in distin-guishing branchial cleft cysts fromcystic metastases of head and neckcancer. Chariton E. Papadakis,M.D.Chania,Crete 73133,GreeceTel.-Fax:+30 2821055654E-mail:papch@otenet.