First Branchial Cleft Anomalies: Rare Work Type I and Type II Entities

First branchial cleft anomalies (FBCAs) are the most infrequent malformations that occur during the development of the branchial apparatus, appearing in less than 8% of all branchial anomalies. Traditionally, they are classified into Work type I and II, depending on their origin. We present a pair of rare FBCAs: a case of a preauricular Work type I cyst with twin fistulae coursing toward the parotid gland and a Work type II cyst of significant dimensions.

Chronic Lateral Neck Mass in an Adolescent Female

Neck masses are a common finding in the pediatric population, with a broad differential diagnosis resulting in real diagnostic challenges. They are most frequently caused by reactive lymphadenopathy, infectious lymphadenitis, or congenital anomalies of the neck. This case report describes a 16-year-old female presenting to the pediatric emergency department with 5 weeks of right-sided neck mass. Based on her history, physical examination, and prolonged clinical course, the differential diagnosis included infectious, congenital, and neoplastic causes. The patient was ultimately diagnosed with a branchial cleft cyst and referred to a pediatric head and neck surgeon.

[Fourth branchial abnormity and management experiences]

OBJECTIVE

To investigate the fourth branchial abnormity and its managements.

METHOD

Twelve cases of the fourth branchial abnormity treated between January 2005 and April 2012 were reviewed.

RESULTS

Dissection of the recurrent laryngeal nerve was done in all cases. Partial thyroidectomy was performed in 10 cases, and 2 cases of them received selective neck dissection including level II, III, IV and VI. The abnormity lesions were found to pass posterior to the thyroid glands in the 10 cases and to pass through the inferior constrictor muscle into the pyriform sinus in 7 cases of them. The internal opening in the pyriform sinus demonstrated by preoperative examination couldn't be identified in the operation in one case. The abnormity tract terminated at the lateral surface of the esophagus in one case, passed into the cervical esophagus in one case, and terminated at the lateral surface of the thyroid gland in one case, and formed a cyst lateral to the thyroid gland in one case. No abnormity tract was found to loop around the hypoglossal nerve and to descend into the mediastinum. The left recurrent laryngeal nerve was cut off in one patient, although end to end anastomosis was performed immediately, the patient was still complicated with left vocal cord paralysis postoperatively. The median follow-up time of the cases was 24 months (8-88 months). One case was lost of follow up. No recurrence was found in 10 cases. Recurrence was found in one case, and no recurrence in 10 cases.

CONCLUSIONS

The presentation of congenital the fourth branchial fistula is variated significantly. Most abnormity lesions had close relations to the thyroid gland and the recurrent laryngeal nerve, thus the recurrent laryngeal nerve need to protect and partial thyroidectomy might be considered. In the recurrent cases when the abnormity couldn't be identified clearly, selective neck dissection including level II, III, IV and VI should be done long term follow up should be carried out in the cases that the internal opening couldn't be found.

A Case of Cystic Metastasis of Lingual Tonsil Carcinoma Diagnosed First as a Branchiogenic Cyst

We report a case of lingual tonsil carcinoma diagnosed first as a branchiogenic cyst. Histopathological findings showed the possibility of a malignant tumor because there was proliferation of the papillary epithelium of the cyst wall. Blind biopsy of the lingual and palatine tonsil was done and the histological findings revealed a cystic metastatic lymph node from a squamous cell carcinoma (SCC) of the lingual tonsil. The diagnosis of the primary unknown cystic metastatic cervieal SCC requires a thorough examination of the palatine or lingual tonsil when there is no evidence of any vestigial remnant of branchiogenic organ.

Malignant branchioma--a further insight

Two cases presented with solitary cystic mass in the usual position of a branchial cyst in the neck are reported. Histology on both cysts reported as carcinoma of a branchial cyst (malignant branchioma). In addition to pre-operative radiotherapy to the neck, and ipsi-lateral radical neck dissection, the oropharynx is irradiated in prophylactic manner only in the second case. The first patient died of tonsillar carcinoma 3.5 years after diagnosis and the second case is well with no sign of recurrence 4 years after the initial diagnosis. The authors discuss the nature and management of the so called malignant branchioma.

Lymphoepithelial cyst in the pancreas: a case report

A case of lymphoepithelial cyst in the pancreas was reported. A 64-year-old man without any specific complaints was found to have a cystic lesion in the anterior portion of the pancreas, as revealed by ultrasonography of the abdomen at an annual medical examination in 1988. This was dissected easily from the pancreas. Histologically, it was diagnosed to be a benign lymphoepithelial cyst in the pancreas. Cysts of this type are rare, and their histogenesis is also not well understood.

So-called branchiogenic carcinoma is actually cystic metastases in the neck from a tonsillar primary

In 1974, we reported on six patients with squamous cell carcinoma arising in the tonsillar area who presented with a characteristic form of cystic nodal metastasis. This study reports on an additional 21 patients with this entity. Treatment of these patients included removal of the cystic metastasis with or without radical neck dissection and irradiation of Waldeyer's ring. Two patients have died of unrelated disease and two were lost to follow-up, but the remainder are alive without disease 2 months to 12 years following initial diagnosis. We believe that cystic metastases from tonsillar squamous cell carcinomas have often been mistaken for either primary squamous cell carcinomas of branchiogenic origin or with branchial cleft cysts. The distinctive histological features of cystic metastases reviewed after its correct identification can lead to the discovery of an unsuspected primary lesion and result in specific treatment options.

Nasopharyngeal cysts. Report of seven cases with review of the literature

A series of seven patients with nasopharyngeal cysts is presented. A review of the pertinent literature and a description of the clinical, radiologic, and pathologic features of these lesions are also included. The role of computed tomography in differentiating nasopharyngeal cysts from other pathologic entities, as well as the importance of surgery as an elective method of treatment, is specifically emphasized.

Common lumps and bumps of the head and neck in infants and children

The majority of lesions in the neck of children will prove to be benign and of congenital origin arising from such structures as the thyroglossal duct and the branchial clefts in addition to hemangiomas and lymphangiomas. However, it is essential that lymphadenopathy be proven infectious and any asymptomatic lymph node enlargement must be considered Hodgkin's disease until proven otherwise. The occasional neuroblastoma or rhabdomyosarcoma presenting in the neck can usually be identified as solid by sonography, leading to early investigation and biopsy. Because of the abundance of important structures that course through the neck, surgery should be conducted in an operating suite with sophisticated, modern anesthetic techniques and with a surgeon experienced in dealing with the full array of lesions that occur.