A Type I first branchial cleft cyst masquerading as a parotid tumor

Abstract

Branchial cleft anomalies are caused by incomplete regression of the cervical sinus of “His” during the 6th and 7th weeks of embryologic development. Although congenital in origin, first branchial cleft cysts (FBCCs) can present later in life. FBCCs are rare causes of parotid swellings, accounting for <1% of all the branchial cleft abnormalities. The diagnosis of FBCCs is a clinical challenge; the condition is often overlooked and mismanaged. We report a case of Type 1 FBCC in a 22-year-old female with an asymptomatic 3.5 cm × 2.5 cm sized cystic mass. It was removed completely under the impression of a cystic tumor of the parotid. On histopathology, the cyst had a squamous epithelium-lined wall with lymphoid aggregation which was characteristic of a branchial cleft cyst. A good understanding of the regional anatomy and embryology can lead to an early diagnosis and thereby effective management of FBCC.

Features of Diagnostics, Clinical Course and Treatment of the Branchial Cleft Cysts

“…Internal jugular vein is marked by white arrow, facial vein -yellow arrow, posterior belly of the digastric muscle -green arrow. branchial cyst of the neck, lateral lymphoepithelial cyst) according to our data has been found in 25% of all cysts of the soft tissue in maxillofacial and neck area [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. The branchial cleft fistulas are rarely detected.…”

“…The surgeon may have difficulties in location place of internal pole of the BCC (Fig 1B), as in this place the internal jugular and facial veins are located. Especially need to be careful upon separating the BCC when its located nearby external and internal carotid arteries (Figs 12,13). With the classical location of BCCs, it is more easy for the surgeon to navigate in the topographic anatomy of those vessels.…”

Branchial cleft cyst in the parotid gland in a human immunodeficiency virus-negative patient

“…BLEC has been associated with HIV infection as part of a diffuse infiltrative lymphocytosis syndrome, in which it is a clinical manifestation of lymphoid hyperplasia in the parotid glands. In recent decades, the HIV epidemic has caused the incidence of parotid gland BLEC to increase [2]. In contrast, BLEC of the parotid gland in HIV-negative patients is extremely rare.…”

“…Branchial cleft cysts are classified into four groups depending on which branch cleft they originated from, with locations ranging from the external auditory canal (in first branchial cleft cysts) to the lower part of the neck (in fourth branchial cleft cysts). Branchial cleft cysts in the parotid gland belong to the category of first branchial cleft cysts [2].…”